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Assessment of Medication Adherence in Patients With Schizophrenia: The Achilles Heel of Adherence Research

Kikkert, Martijn J. MS*; Barbui, Corrado MD; Koeter, Maarten W. J. PhD*; David, Anthony S. MD; Leese, Morven PhD; Tansella, Michele MD; Gieler, Anne MS§ß; Puschner, Bernd PhD; Schene, Aart H. MD, PhD*

The Journal of Nervous and Mental Disease: April 2008 - Volume 196 - Issue 4 - p 274-281
doi: 10.1097/NMD.0b013e31816a4346
Original Article

Measuring medication adherence in patients with schizophrenia is difficult and lacks a gold standard. Consequently, a great number of different methods and instruments have been proposed. Although it has been assumed that they all measure medication adherence, this study demonstrates that instruments differ significantly. Using data from an international multisite study (N = 329), we found that 3 questionnaires, designed to measure medication adherence and typical for instruments used in studies in patients with schizophrenia, do not agree in labeling patients as nonadherent. Further, they seem not to measure the same trait, are related to different established risk factors of nonadherence, and are only weakly related to these established risk factors of nonadherence. If these results are representative of the validity of other measures used in adherence research, this may have serious consequences for the interpretation of, and explanations for discrepancies found in the literature. Researchers should be aware of this problem and continue to combine objective and subjective methods in the hope of increasing the reliability and validity of measures of adherence.

*Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; †Department of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; ‡Institute of Psychiatry, Kings College, London, United Kingdom; §Department of Psychiatry, Leipzig University, Leipzig, Germany; and ∥Department of Psychiatry II, Ulm University, Günzburg, Germany.

Send reprint requests to M. J. Kikkert, MS, Academisch Medisch Centrum, Psychiatric Centre, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.