Caregiver Factors Significantly Influence Medication Adherence

Psychosocial and socioeconomic family caregiver factors were significantly associated with medication adherence for people with schizophrenia and type 2 diabetes (T2D), according to a study in the Journal of the American Pharmacists Association.¹ Researchers’ key findings highlighted positive adherence outcomes regarding caregivers’ mental health literacy and access to online health information, and negative associations were identified regarding caregiver income and sense of coherence.

“About 87.7% of people aged 62 to 85 years are prescribed a medication, of whom 35.8% have concomitant use of at least 5 medications,” according to a study published in Frontiers of Public Health.² “The complexity of pharmacological treatments prescribed to patients can cause problems of adherence to treatment, preventing the expected therapeutic benefits, hence the need for medication management and administration depend on the caregiver or immediate family member playing a key role in treatment.”

Globally, chronic illnesses like schizophrenia and T2D present massive clinical and financial hurdles. Schizophrenia impacts approximately 24 million people worldwide, requiring lifelong antipsychotic therapies that are frequently disrupted by severe side effects and poor patient insight.^1,3,4

Affected individuals suffer a reduced life expectancy of 15 to 20 years, with cardiovascular complications like T2D acting as a major contributor to premature mortality. T2D is another leading public health challenge, currently affecting 537 million adults globally.¹

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The Dual Burden of Complex Treatment Regimens

When these 2 conditions coexist, patients face an exceptionally high risk of medication-related problems due to the combined effects of cognitive impairments, metabolic adverse effects, and polypharmacy. National survey data indicates that medication nonadherence rates stand at around 24% for schizophrenia and range between 30% and 40% for T2D, with comorbid cases likely suffering even higher rates due to treatment complexity.^1,5

A cross-sectional study in eastern India confirmed this widespread vulnerability, finding that only 34.14% of diabetic outpatients achieved appropriate medication adherence on their own.³

For pharmacists, these statistics represent a critical call to action. The CDC reports that about 50% of chronic disease medications are not taken as prescribed, and 20% to 30% of all prescriptions are never even filled.⁵

When patients with severe psychiatric or metabolic conditions struggle to manage their complex treatment plans, they face a heightened risk of relapse, unnecessary hospitalizations, and preventable health care costs.^1,3,4

Socioeconomic and Psychosocial Predictors of Adherence

To address this challenge, health care professionals must shift their focus to the family caregivers who supervise daily medication administration. The current study, featuring 530 family caregivers in northeastern Thailand, demonstrated that medication adherence is primarily driven by caregiver-specific psychosocial and socioeconomic characteristics rather than patient-level clinical variables.¹

Among these predictors, caregiver mental health literacy emerged as the single most powerful positive driver of compliance. Caregivers with higher mental health literacy are significantly better equipped to understand chronic disease trajectories, recognize early symptoms of relapse, and effectively manage complex pharmacological regimens.

Access to reliable health information via the internet was also a strong positive predictor, serving as an essential tool for caregivers to seek timely advice on drug use and side effect management.¹

Conversely, some caregiver factors showed unexpected negative correlations with adherence. Higher caregiver income was negatively associated with medication adherence, which researchers attribute to increased occupational demands and a corresponding lack of time available for strict medication supervision.

A strong sense of coherence among caregivers in rural agricultural settings unexpectedly predicted lower adherence, as caregivers might adopt a more relaxed, acceptance-based coping style that reduces intensive daily supervision of the patient’s drug routine.¹

Similar family-centered dynamics are apparent in neurodegenerative care, where a study of 100 dementia caregivers found that overall adherence was 71%, with significantly higher compliance observed when the caregiver was female or a first-degree relative, such as a spouse or child. Conversely, male caregivers and nonfirst-degree relatives were statistically significant predictors of potential treatment nonadherence.²

Collaborative Care and Pharmacist-Led Interventions

Pharmacists can bridge these adherence gaps by moving beyond the traditional dispensing counter and engaging in collaborative care. The CDC strongly advocates for collaborative drug therapy management, where pharmacists work directly with physicians to perform comprehensive medication reviews, educate families on safe drug use, and coordinate care to optimize therapy.⁵

The immense potential of pharmacist-led community interventions is vividly demonstrated by Indonesia’s “Si-Care” program. In this community home care model, trained pharmacists made 7 home visits over 4 months to provide personalized counseling and symptom monitoring for outpatients with schizophrenia and their families.⁴

Pharmacists actively addressed side effects, such as extrapyramidal symptoms, sedation, and dry mouth, by offering practical management strategies or coordinating dosage adjustments directly with physicians. By using educational booklets and establishing direct accountability through regular pill counts, the program achieved extraordinary results, with mean medication adherence rising from 77.38% at baseline to 97.57% at the final visit while maintaining clinical symptom stability.

By actively strengthening caregivers’ mental health literacy, recommending reliable online health resources, and accommodating the household’s socioeconomic realities, pharmacists can transform the landscape of community chronic disease management.¹

“The findings highlighted the importance of family caregiver-centered medication adherence interventions that strengthened [mental health literacy], promoted access to reliable health information, and considered family caregivers’ socioeconomic contexts to enhance pharmaceutical care and improve long-term treatment outcomes in mental health settings,” concluded the authors of the current study.

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REFERENCES

1. Detworrawatin P, Srichaijaroonpong S, Phoosuwan N. Factors predicting medication adherence among family caregivers of people with schizophrenia and type 2 diabetes mellitus: a hospital-based cross-sectional study. JAPhA. 2026;66(5):103487. doi:10.1016/j.japh.2026.103487

2. Muñoz-Contreras MC, Segarra I, López-Román FJ, et al. Role of caregivers on medication adherence management in polymedicated patients with Alzheimer's disease or other types of dementia. Front Public Health. 2022 Oct 24;10:987936. doi: 10.3389/fpubh.2022.987936

3. Sahoo J, Mohanty S, Kundu A, et al. Medication adherence among patients of type II diabetes mellitus and its associated risk factors: a cross-sectional study in a tertiary care hospital of eastern India. Cureus. 2022 Dec 29;14(12):e33074. doi: 10.7759/cureus.33074

4. Cahaya N, Kristina SA, Widayanti AW, et al. Pharmacist-led si-care (schizophrenia care) model to improve medication adherence and symptom management in schizophrenia. Explor Res Clin Soc Pharm. 2024 Nov 22;16:100544. doi: 10.1016/j.rcsop.2024.100544

5. Promoting medication management. CDC. May 15, 2024. Accessed August 24, 2026. https://www.cdc.gov/diabetes/hcp/clinical-guidance/promote-medication-management.html