Abstract
Schizophrenia is a severe chronic mental disorder characterized by symptoms that affect human thought processes, emotions, and behavior. This study aimed to explore nurses' perspectives on therapy adherence among individuals with schizophrenia in Indonesia, focusing on types of therapy programs, causes of non-adherence, consequences of non-adherence, barriers to adherence, and strategies for improving continuity of care. A qualitative phenomenological approach was employed, involving in-depth interviews with 11 nurses purposively selected from psychiatric hospitals and mental health clinics across Indonesia. Participants had at least three years of experience in schizophrenia care. Data were analyzed using the Colaizzi method to identify themes and subthemes. Five key themes emerged: (1) Types of therapy programs (nursing therapy, psychopharmacology, psychotherapy); (2) Causes of non-adherence (negative attitudes, lack of family support, drug side effects, healthcare system challenges, economic barriers); (3) Consequences of non-adherence (relapse, rehospitalization, social and familial impacts); (4) Barriers to adherence (nurse-related, doctor-related, patient-related, and family-related obstacles); and (5) Continuity of care (increasing resources, health collaboration, service integration). Nurses emphasized the need for multidisciplinary collaboration and systemic improvements to enhance adherence. The study highlights the multifaceted challenges in achieving therapy adherence among schizophrenia patients in Indonesia. Addressing these issues requires tailored interventions, stronger family and healthcare provider support, and integrated care models. These findings can inform policy and practice to reduce relapse rates and improve patient outcomes.
References
Berge, J., Sundell, K., Ojehagen, A., & Hakansson, A. (2016). Role of parenting styles in adolescent substance use: Results from a Swedish longitudinal cohort study. BMJ Open, 6(1), e008979. https://doi.org/10.1136/bmjopen-2015-008979
Bernardo, M., Amoretti, S., Cuesta, M. J., Parellada, M., Mezquida, G., Gonzáles-Pinto, A., & Micó, J. A. (2020). The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design. Revista de Psiquiatría y Salud Mental. https://pubmed.ncbi.nlm.nih.gov/34456031/
Brink, S. (2004). New therapies in Schizophrenia. South African Family Practice, 46(4), 16 – 18. https://doi.org/10.1080/20786204.2004.10873066
Chan, S. K. W., Chan, H. Y. V., Liao, Y., Suen, Y. N., Hui, C. L. M., Chang, W. C., Lee, E. H. M., & Chen, E. Y. H. (2022). Longitudinal relapse pattern of patients with first-episode schizophrenia-spectrum disorders and its predictors and outcomes: A 10-year follow-up study. Asian Journal of Psychiatry, 71. https://doi.org/10.1016/j.ajp.2022.103087
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., McGrath, J. J., & Whiteford, H. A. (2018). Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016. Schizophrenia Bulletin, 44(6), 1195–1203. https://doi.org/10.1093/schbul/sby058
El-Missiry, A., Elbatrawy, A., El Missiry, M., Moneim, D. A., Ali, R., & Essawy, H. (2015). Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia. Journal of Psychiatric Research, 70, 106–112. https://doi.org/10.1016/j.jpsychires.2015.09.006
Emsley, R., Alptekin, K., Azorin, J.-M., Cañas, F., Dubois, V., Gorwood, P., Haddad, P. M., Naber, D., Olivares, J. M., Papageorgiou, G., Roca, M., Thomas, P., Hargarter, L., & Schreiner, A. (2015). Nurses’ perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey. Therapeutic Advances in Psychopharmacology, 5(6), 339–350. https://doi.org/10.1177/2045125315612013
Emsley, R., Chiliza, B., & Asmal, L. (2013). The evidence for illness progression after relapse in schizophrenia. Schizophrenia Research, 148(1–3), 117 – 121. https://doi.org/10.1016/j.schres.2013.05.016
Gleeson, J. F., McGuckian, T. B., Fernandez, D. K., Fraser, M. I., Pepe, A., Taskis, R., Alvarez-Jimenez, M., Farhall, J. F., & Gumley, A. (2024). Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders. Clinical Psychology Review, 107. https://doi.org/10.1016/j.cpr.2023.102357
Godin, O., Leboyer, M., Schürhoff, F., Llorca, P.-M., Boyer, L., Andre, M., Andrianarisoa, M., Aouizerate, B., Berna, F., Capdevielle, D., Chereau, I., Dorey, J.-M., Dubertret, C., Dubreucq, J., Faget, C., Lancon, C., Leignier, S., Mallet, J., Misdrahi, D., … Fond, G. (2018). Metabolic syndrome and illness severity predict relapse at 1-year follow-up in schizophrenia: The FACE-SZ cohort. Journal of Clinical Psychiatry, 79(6). https://doi.org/10.4088/JCP.17m12007
Greydanus, D. E., Calles Jr., J. L., & Patel, D. R. (2008). Schizophrenia in childhood and adolescence. In Pediatric and Adolescent Psychopharmacology (pp. 133–154). Cambridge University Press. https://doi.org/10.1017/CBO9780511544705.011
Hamanu, A. O., Yusuf, A., & Patra, R. F. K. (2019). An analysis of factors associated with the relapse history of clients with schizophrenia at an outpatient polyclinic. Indian Journal of Public Health Research and Development, 10(9), 1380 – 1384. https://doi.org/10.5958/0976-5506.2019.02639.1
Haram, A., Fosse, R., Jonsbu, E., & Hole, T. (2019). Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00204
Hasan, A. A. (2019). Factors that Leading to The Schizophrenic Patient to Leave Psychotherapy. Indian Journal of Forensic Medicine & Toxicology, 13(4), 1194. https://doi.org/10.5958/0973-9130.2019.00463.8
Higashi, K., Medic, G., Littlewood, K. J., Diez, T., Granström, O., & De Hert, M. (2013). Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology, 3(4), 200–218. https://doi.org/10.1177/2045125312474019
Hudson, T. J., Owen, R. R., Thrush, C. R., Han, X., Pyne, J. M., Thapa, P., & Sullivan, G. (2004). A Pilot Study of Barriers to Medication Adherence in Schizophrenia. The Journal of Clinical Psychiatry, 65(2), 211–216. https://doi.org/10.4088/JCP.v65n0211
Hui, C. L.-M., Tang, J. Y.-M., Leung, C.-M., Wong, G. H.-Y., Chang, W.-C., Chan, S. K.-W., Lee, E. H.-M., & Chen, E. Y.-H. (2013). A 3-year retrospective cohort study of predictors of relapse in first-episode psychosis in Hong Kong. Australian and New Zealand Journal of Psychiatry, 47(8), 746 – 753. https://doi.org/10.1177/0004867413487229
Idaiani, S., Yunita, I., Tjandrarini, D., Indrawati, L., Darmayanti, I., Kusumawardani, N., & Mubasyiroh, R. (2019). Prevalensi Psikosis di Indonesia berdasarkan Riset Kesehatan Dasar 2018. Jurnal Penelitian Dan Pengembangan Pelayanan Kesehatan, 3(1), 9–16. https://doi.org/10.22435/jpppk.v3i1.1882
Jorgensen, K., Rasmussen, T., Hansen, M., & Andreasson, K. (2021). Recovery-oriented intersectoral care between mental health hospitals and community mental health services: An integrative review. International Journal of Social Psychiatry, 67(6), 788–800. https://doi.org/10.1177/002076402096663
Kazadi, N. J. B., Moosa, M. Y. H., & Jeenah, F. Y. (2008). Factors associated with relapse in schizophrenia. South African Journal of Psychiatry, 14(2), 52 – 62. https://doi.org/10.4102/sajpsychiatry.v14i2.158
Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, M. F., Young, A. S., Degenhardt, A., & Hong, S.-H. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Journal of Psychiatry, 177(9), 868–872. https://doi.org/10.1176/appi.ajp.2020.177901
Khamker, N. (2015). First episode schizophrenia. South African Family Practice, 57(5), 29 – 33. https://doi.org/10.4102/safp.v57i5.4345
Macdonald, A., Adamis, D., Broadbent, M., Craig, T., Stewart, R., & Murray, R. M. (2021). Continuity of care and mortality in people with schizophrenia. BJPsych Open, 7(4), e127. https://doi.org/10.1192/bjo.2021.965
Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery. Issues in Mental Health Nursing, 37(5), 372–379. https://doi.org/10.3109/01612840.2016.1157228
McCabe, R., Healey, P. G. T., Priebe, S., Lavelle, M., Dodwell, D., Laugharne, R., Snell, A., & Bremner, S. (2013). Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93(1), 73–79. https://doi.org/10.1016/j.pec.2013.05.015
Moges, S., Belete, T., Mekonen, T., & Menberu, M. (2021). Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. International Journal of Mental Health Systems, 15(1), 42. https://doi.org/10.1186/s13033-021-00464-0
Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00761
Offord, S., Lin, J., Mirski, D., & Wong, B. (2013). Impact of Early Nonadherence to Oral Antipsychotics on Clinical and Economic Outcomes Among Patients with Schizophrenia. Advances in Therapy, 30(3), 286–297. https://doi.org/10.1007/s12325-013-0016-5
Oyediran, O. O., Ajao, O. O., & Oyelade, O. O. (2019). A Retrospective Study of Relapse among Mentally Ill Clients Receiving Care in Selected Teaching Hospitals in a South Western State, Nigeria. Journal of Mental Health, 1(2), 30–39. https://web.archive.org/web/20200306222001/https://zenodo.org/record/3353822/files/%2830-39%29CE%20Study%20Of%20Relapse%20Among%20Mentally%20Ill%20Clients-format.pdf
Pothimas, N., Tungpunkom, P., Chanprasit, C., & Kitsumban, V. (2020). A cross-sectional study of factors predicting relapse in people with schizophrenia. Pacific Rim International Journal of Nursing Research, 24(4), 448 – 459. https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/226797
Rivelli, A., Fitzpatrick, V., Nelson, M., Laubmeier, K., Zeni, C., & Mylavarapu, S. (2024). Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system. Schizophrenia, 10(1). https://doi.org/10.1038/s41537-024-00448-2
Rohmi, F., & Rumambo Pandin, M. G. (2022). Factors Affecting Medication Adherence Among patient with Schizophrenia: A Literature Review. https://doi.org/10.1101/2022.01.12.22269187
Rubio, J. M., Schoretsanitis, G., John, M., Tiihonen, J., Taipale, H., Guinart, D., Malhotra, A. K., Correll, C. U., & Kane, J. M. (2020). Psychosis relapse during treatment with long-acting injectable antipsychotics in individuals with schizophrenia-spectrum disorders: an individual participant data meta-analysis. The Lancet Psychiatry, 7(9), 749 – 761. https://doi.org/10.1016/S2215-0366(20)30264-9
Sato, A., Moriyama, T., Watanabe, N., Maruo, K., & Furukawa, T. A. (2023). Development and validation of a prediction model for rehospitalization among people with schizophrenia discharged from acute inpatient care. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1242918
Schoretsanitis, G., Kane, J. M., Correll, C. U., & Rubio, J. M. (2022). Predictors of Lack of Relapse after Random Discontinuation of Oral and Long-acting Injectable Antipsychotics in Clinically Stabilized Patients with Schizophrenia: A Re-analysis of Individual Participant Data. Schizophrenia Bulletin, 48(2), 296 – 306. https://doi.org/10.1093/schbul/sbab091
Shah, C. (2019). Study of various factors affecting compliance in schizophrenia: A single center experience in India. Archives of Psychiatry and Psychotherapy, 21(3), 41–52. https://doi.org/10.12740/APP/105489
Stuart, G. W., Keliat, B. A., & Pasaribu, J. (2016). Prinsip dan Praktik Keperawatan Kesehatan Jiwa Stuart: Indonesia (1st ed.). Elsevier. https://books.google.co.id/books/about/Prinsip_dan_Praktik_Keperawatan_Kesehata.html?id=WamJEAAAQBAJ&redir_esc=y
Sun, L., Wang, Z., & Fang, J. (2023). Research Applications of Positron Emission Tomography/Magnetic Resonance (PET/MR) Imaging in Schizophrenia. In PET/MR: Functional and Molecular Imaging of Neurological Diseases and Neurosciences. https://doi.org/10.1007/978-981-19-9902-4_15
Tandon, R. (2012). The Nosology of Schizophrenia. Toward DSM-5 and ICD-11. Psychiatric Clinics of North America, 35(3), 557 – 569. https://doi.org/10.1016/j.psc.2012.06.001
Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., Malaspina, D., Owen, M. J., Schultz, S., Tsuang, M., Van Os, J., & Carpenter, W. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research, 150(1), 3 – 10. https://doi.org/10.1016/j.schres.2013.05.028
Tham, X. C., Xie, H., Chng, C. M. L., Seah, X. Y., Lopez, V., & Klainin-Yobas, P. (2018). Exploring predictors of medication adherence among inpatients with schizophrenia in Singapore’s mental health settings: A non-experimental study. Archives of Psychiatric Nursing, 32(4), 536–548. https://doi.org/10.1016/j.apnu.2018.02.004
Thomas, P. (2013). Relapse: Causes and consequences; [Les rechutes: causes et conséquences]. Encephale, 39(SUPPL.2), S79–S82. https://doi.org/10.1016/S0013-7006(13)70100-3
Üçok, A., & Kara, İ. A. (2020). Relapse rates following antipsychotic discontinuation in the maintenance phase after first-episode of schizophrenia: Results of a long-term follow-up study. Schizophrenia Research, 225, 31–38. https://pubmed.ncbi.nlm.nih.gov/31653578/
Villaverde, O. (2007). Diabetes mellitus and schizophrenia. In Psychiatric Disorders and Diabetes Mellitus. https://doi.org/10.3109/9780203931592-4
World Health Organization. (2022). World Mental Health Report: Transforming Mental Health For All. https://www.who.int/publications/i/item/9789240049338
Yu, W., Tong, J., Sun, X., Chen, F., Zhang, J., Pei, Y., Zhang, T., Zhang, J., & Zhu, B. (2021). Analysis of Medication Adherence and Its Influencing Factors in Patients with Schizophrenia in the Chinese Institutional Environment. International Journal of Environmental Research and Public Health, 18(9), 4746. https://doi.org/10.3390/ijerph18094746
Z, N., Muraraiah, S., & H, C. (2019). Medication adherence in schizophrenia: Understanding patient’s views. National Journal of Physiology, Pharmacy and Pharmacology, 1. https://doi.org/10.5455/njppp.2019.9.0206002032019
Zielasek, J., & Gaebel, W. (2015). Schizophrenia. In International Encyclopedia of the Social & Behavioral Sciences: Second Edition. https://doi.org/10.1016/B978-0-08-097086-8.27062-1

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Ice Yulia Wardani, Achir Yani Hamid, Novy Helena Catharina Daulima, Sally Rahadi Asih, Riska Amalya Nasution

