Theoretical Approaches to Enhancing Motivation for Adherence to Antidepressant Medications

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Abstract

Problem: Adherence to antidepressants is a major challenge in our health care system, with a high percentage of patients discontinuing their medications within six months. Aims: The purpose of this position paper is to discuss theoretical frameworks that address the psychological beliefs, benefits and barriers and feelings of autonomy that affect a person's willingness and motivation to take anti-depressant medications within a therapeutic relationship with a nurse practitioner. Methods: Three theoretical frameworks were selected to highlight particular perspectives relevant to enhancing patient motivation for medication adherence. The Self-Regulation Model, Health Belief Model, and Self-Determination Theory combined with motivational interviewing all offer guidance on strategies for improving adherence to antidepressants. Conclusions: The Self-Regulation Model underscores the importance of illness representations that prompt considering patient perceptions of depression that affect adherence. The Health Belief Model focuses on cost–benefit considerations that affect patient's adherence, along with perceived control. Finally, Self-Determination Theory combined with motivational interviewing offers strategies that enhance autonomy and optimize collaboration and motivation for adherence. Relevance for clinical practice: These three theoretical models are applied to a vignette for a patient who is having difficulty with adherence to antidepressant medication.

Section snippets

Background

Among psychiatric patients, bipolar and schizophrenic spectrum disorders have the lowest rates of adherence, with adherence rates as low as 24% reported for individuals with schizophrenia (Kane, Kishimoto, & Correll, 2013). For this reason, much of the psychiatric literature on medication non-adherence has focused on schizophrenia (Farooq & Naeem, 2014), with mixed response rates to treatment with psychosocial interventions and motivational interviewing (Barkhof et al., 2012, Barkhof et al.,

Theoretical frameworks

A number of cognitive theoretical frameworks have been used to address medication adherence issues, including Self-Regulation Model (Leventhal, Meyer, & Nerenz, 1980); Health Belief Model (Rosenstock, 1974); Social Cognitive Theory (Bandura, 1986); the Theory of Planned Behavior (Ajzen, 1985); Adult Learning Theory (Knowles, 1980); the Medication Adherence Model (Johnson, 2002), and Self-Determination Theory (Deci & Ryan, 1985). All of these theories offer helpful insights for psychiatric nurse

Vignette

Sue, a 27 year old married women, presented for a diagnostic assessment and treatment one month ago for significant symptoms of postpartum depression that began three weeks after the birth of her second child and have become progressively worse. She was referred for a psychiatric evaluation by her woman's health nurse practitioner. She is currently bottle feeding the baby, who is now three months old. She recalls having three previous episodes of depression, one in high school and two in

Discussion

The theories discussed in this paper are applied individually to the case of a patient, Sue. The Self-Regulation Model underscores the importance of how Sue conceptualizes her illness and her ability to problem solve, and enables the NP to partner with her in engaging in reappraisal of the perceived threats to her health and identity. The Health Belief Model focused on cost–benefit considerations that affect Sue's decision regarding medication adherence as well recognizing the importance of

Conclusion

Many health behavior theories may provide guidance for the nurse clinician attempting to enhance medication adherence. The Self-Regulation Model, Health Belief Model, and Self-Determination Theory combined with motivational interviewing all offer strategies that may be particularly helpful for improving adherence to antidepressants. The Self-Regulation Model describes illness representations that prompt providers to address perceptions of depression from the patient's perspective that can

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    All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and all authors are in agreement with the manuscript.

    The authors have no financial conflicts of interest

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