title: The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities.
abstract: OBJECTIVE
  To determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions.
  
  
  METHODS
  Qualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments.
  
  
  RESULTS
  Participants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals.
  
  
  CONCLUSIONS
  A rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0003-4492-0442
authors.initials: D
authors.lastname: Poremski
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Vathsala D/O
authors.initials: VD
authors.lastname: Sagayadevan
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Peizhi
authors.initials: P
authors.lastname: Wang
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Alvin
authors.initials: A
authors.lastname: Lum
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Mythily
authors.initials: M
authors.lastname: Subramaniam
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Chong Siow
authors.initials: CS
authors.lastname: Ann
mesh_terms: D015897:Comorbidity; D006801:Humans; D055118:Medication Adherence; D008659:Metabolic Diseases / Q000453:epidemiology*; D012559:Schizophrenia / Q000453:epidemiology* / Q000628:therapy*; D057545:Social Stigma; D012944:Social Support