title: The effectiveness of compliance therapy on drug attitude among schizophrenic patients: a systematic review.
abstract: BACKGROUND
  Schizophrenia is one of the most severe mental illnesses. Studies have found that 25% to 80% of all schizophrenic patients are non-compliant in medication-taking. Non-compliance of medication-taking is associated with higher readmission rates that result from relapses. Compliance therapy has been developed to modify negative beliefs toward medication and aims to improve drug attitude toward medication-taking. However, the effect of compliance therapy on drug attitude among schizophrenic patients is unclear.
  
  
  OBJECTIVE
  The objective of this review was to systematically review the available evidence with regards to the effect of compliance therapy on improving attitudes toward medication among schizophrenic patients.
  
  
  METHODS
  
  
  
  METHODS
  People diagnosed with schizophrenia, schizophrenia-form disorder, delusion disorder, schizo-affective disorder. TYPES OF INTERVENTION(S): The review considered studies that evaluated any form of compliance therapy. The comparator was standard care. TYPES OF STUDIES: The review considered randomized controlled trials. TYPES OF OUTCOMES: Drug attitude measured by the Drug Attitude Inventory.
  
  
  METHODS
  Database searches included MEDLINE, CINAHL, EMBASE, Science Direct, SocIndex, PsycINFO, ERIC, the Web of Science, the National Central Library and the Chinese Electronic Periodical Services databases. Searches were limited to English and Chinese. Search was limited to articles published from 1983 to 2013.
  
  
  METHODS
  Two reviewers independently appraised the studies using the standardized critical appraisal checklist for randomized control trial and pseudo-randomized trails designed by Joanna Briggs Institute. Disagreements were resolved through discussion.
  
  
  METHODS
  A standardized data extraction tool from the Joanna Briggs Institute was used. Data were extracted by two reviewers independently.
  
  
  RESULTS
  Due to the concern of heterogeneity, meta-analysis was not considered as an appropriate approach to synthesize data in the current review. A narrative summary was therefore carried out.
  
  
  RESULTS
  Three randomized controlled trials met the inclusion criteria. Two studies compared compliance therapy to standard care and both found compliance therapy to significantly improve drug attitude (Drug Attitude Inventory: 1 randomized controlled trial, n=28, mean difference between groups: 4.32, 'p'=0.001; 1 randomized controlled trial, n=47 mean difference between groups: 2.2, 'p<0.001').However, the other study reported that there was no statistically significant difference in the drug attitude score between the two groups (Drug Attitude Inventory: n=50, mean difference between groups: -2.1 'p=0.32').
  
  
  CONCLUSIONS
  The present review found that the majority of the included studies identified an effect of compliance therapy in improving drug attitude. However, the evidence is still weak as the outcome was from three small and heterogeneous studies. Standardization of the compliance therapy and well-designed study is needed to test the effect in the future. Only then, can the therapy be considered to improve attitude toward medication taking among schizophrenic patients.
authors.affiliation: Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan..|Taiwanese Centre for Evidence-based Health Care: an Affiliate Center of the Joanna Briggs Institute.
authors.forename: Ying-Tzu
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Department of Nursing and Research Centre for Environment and Physical Activity, Tzu Chi College of Technology, Hualien, Taiwan.|Taiwanese Centre for Evidence-Based Health Care: an Affiliate Center of the Joanna Briggs Institute.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Lee
mesh_terms: D001294:Attitude to Health; D006801:Humans; D055118:Medication Adherence; D010349:Patient Compliance; D012559:Schizophrenia / Q000188:drug therapy*
keywords: Attitude Drug Inventory; Meta-analysis; compliance therapy; schizophrenia