Application Of Education Intervention Based On IIFAR Program In Medication Adherence Of Patients With Bipolar Disorder

ObjectivesThis study investigated the effect of IIFAR-based education intervention on medication adherence,confidence in medication adherence,intention to take medication,and medication-related beliefs in patients with bipolar disorder,as well as the patients’attitudes and satisfaction with this intervention.The study aimed to find a safe,effective and easy-to-implement intervention for improving medication adherence in patients with bipolar disorder.MethodsThis study was a randomized controlled trail study.Seventy-six patients with bipolar disorder,attending the mental health department of a tertiary general hospital in Lanzhou City and a tertiary psychiatric hospital in Tianshui City and meeting the inclusion and exclusion criteria,were selected for the study,from February 2022 to February 2023.Participants were grouped according to the patients’admission time using a randomized number table.Finally,38 cases in the intervention group and 38cases in the control group were included.Patients in the control group received routine health education and follow-up in the ward,while the patients in the intervention group received a 4-week online education intervention based on the IIFAR program.The Morisky Medication Adherence Scale,Medication Adherence Confidence Score,Medication Adherence Intention Score and Medication-Related Beliefs Questionnaire were used to assess the medication adherence,medication adherence confidence,medication adherence intention and medication-related beliefs of patients in both groups at baseline（T₀）,after completion of the intervention（T₁）and at 3 months post-intervention follow-up（T₂）.In addition,the Intervention Attitude Questionnaire was administered to patients in the intervention group after the intervention to assess their attitudes and satisfaction with the intervention process.In this study,Intention to Treat Analysis was used,and patients who completed both T₀ and T₁ data collection were included in the outcome analysis.The t-test,rank sum test,and generalized mixed linear model were used to evaluate the intervention effect.Results1.Thirty-six participants in the intervention group and 35 in the control group were included in the data analysis.The differences in the general information and outcome index data at baseline were not statistically significant and were balanced and comparable in two groups.The mean age of the 71 participants at baseline was 23.79±6.62 years,80.3%of them had been re-hospitalized due to relapses,and 60.6%had a disease duration exceeding one year,with a mean disease duration of 3.06±3.19 years.The medication adherence score was 4.06±2.26,and the medication adherence rate was23.94%,indicating that the patients’medication adherence was poor.The scores of patients’confidence in medication adherence,willingness to take medication adherence and related beliefs were 6.27±2.66 points,6.13±3.00 points and 34.18±8.37 points,respectively,which were at a moderate level.2.Analysis of intervention effects:（1）The medication adherence score of patients in the intervention group（5.26±1.91 points）was higher than that of patients in the control group（4.10±2.39points）,the comparison of medication adherence scores measured after intervention completion（T₁）was statistically significant（P=0.028,<0.05）.Compared to baseline（T₀）,the medication adherence scores for patients in the intervention group were statistically significant（P=0.000,<0.05）.Medication adherence scores for the effect of intervention were not statistically significant（P>0.05）,but were significant for the effect of time and interaction（P=0.017,<0.05;P=0.000,<0.05）.（2）The comparison of medication adherence confidence score measured after intervention completion（T₁）was not statistically significant（P=0.065,>0.05）in both groups.Compared to baseline（T₀）,the medication adherence confidence score of patients in the intervention group after the completion of intervention（T₁）and at the 3-month follow-up（T₂）were statistically significant（P=0.003,<0.05;P=0.011,<0.05）.Medication adherence confidence scores for both the effect of intervention and time were not statistically significant（P>0.05）,but were significant for the interaction effect（P=0.033,<0.05）.（3）The comparison of the intention to take medication adherence score measured after the intervention completion（T₁）was statistically significant in the both groups（P=0.041,<0.05）.Compared to baseline（T₀）,the intention to take medication adherence scores of patients in the intervention group after the completion of intervention（T₁）and at the 3-month follow-up（T₂）were statistically significant（P=0.008,<0.05;P=0.034,<0.05）.Intention to take medication adherence scores for effects of intervention,time and interaction were not statistically significant（P>0.05）.（4）The comparison of the scores of medication-related beliefs and the four dimensions including perceived efficacy,perceived need to take medication,medication concerns and medication convenience measured after the completion of the intervention（T₁）were not statistically significant（P>0.05）in both groups.Compared to the 3-month follow-up（T₂）,the Perception of Need for Medication dimension scores of patients in the intervention group after the completion of intervention（T₁）and baseline（T₀）were statistically significant（P=0.000,<0.05;P=0.000,<0.05）.Medication-related beliefs and the rest dimension in the effect of time,intervention and interaction were not statistically significant（P>0.05）in both groups,but the perception of need to take medication dimension scores were significant for the effect of time（P=0.000,<0.05）.（5）91.67%（33/36）of the patients in the intervention group were satisfied with the content of the education intervention based on the IIFAR program,88.89%（32/36）satisfied with the method,88.89%（32/36）satisfied with helping them understand the disease in depth,and 83.33%（30/36）satisfied with helping them adhere to the correct medication.ConclusionsEducation intervention based on the IIFAR program can effectively improve medication adherence in patients with bipolar disorder in the short term,help build confidence about taking medication,and increase patients’willingness to take medication.However,the long-term effect and effect on establishment of medication-related beliefs was not significant and needs to be further studied.Meanwhile,patients with bipolar disorder in the intervention group were satisfied with the intervention.This study provides a reference for the construction of an intervention program to improve medication adherence in patients with bipolar disorder.