incident rate ranging from 20% to 60% (Berk, Berk
& Castle, 2004; Colom & Lam, 2005; Lingam &
Scott, 2002).
Medication non-adherence is associated with
elevated rates of relapse, hospitalization, suicidal
behavior, greater cost to caring (Adam & Scott, 2000;
Colom, Vieta, Tacchi, Sanchez-Moreno, & Scott,
2005; Depp, Lebowits, Patterson, Lacro, & Jeste
2007; Sajatovic, Bauer, Kilbourne, Vertrees, &
Williford, 2006; Scott & Tacchi, 2002), and
consequently a poor quality of life (Crowe, Wilson, &
Inder, 2011). Several factors contribute to
medication non-adherence among patients with
bipolar disorder including age (Baldessarini, Perry, &
Pike, 2007; Berk et al., 2010; Hou, Cleak, & Peveler,
2010), gender, marital status, substance abuse (Berk et
al., 2010; Clatworthy, Bowskill, Rank, Parham, &
Horne, 2007; Sajatovic, Bauer, Kilbourne, Vertrees,
& Williford, 2006; Sajatovic, Velligan, Weiden,
Valenstein, & Ogedegbe, 2010), phase/stage of
illness (Berk et al., 2010; Colom et al., 2005),
medication knowledge (Berk et al., 2010; Rosa et
al., 2009; Seo & Min, 2005), an individual’s beliefs
and attitude (Adams & Scott, 2000; Clatworthy et
al., 2007; Clatworthy et al., 2009; Lan, Shiau & Lin,
2003; Scott & Pope, 2002), cognitive illness
representation (Brown et al., 2001; Hou et al., 2010;
Lobban et al., 2003; Sajatovic et al., 2009a),
theurapeutic alliance (Berk et al., 2004; Lingam &
Scott, 2002), social support (Berk et al., 2010; Seo &
Min, 2005), and medication side effects (Clatworthy
et al., 2009; Patel & David, 2007; Sajatovic et al.,
2011).
In the following article, we review the literature
on medication adherence among patient with bipolar
disorder and discuss the small research based on
how the concepts are linked.
2
FINDINGS
2.1 Definition and Nomenclature
In the literature review, there are three terms related
to a patient’s medication taking behavior;
compliance, adherence, and concordance. In terms
of compliance and adherence, these terms reflect
different meanings in a patient’s action in taking
medication. However, some authors have often used
compliance and adherence interchangeably because
they want to shift away from negative connotation of
compliance which is coercion. Even though they used
adherence to replace compliance, however, they may
use the same measurement. For instance, in Berk’s
literature review (as cited in Berk et al., 2010), some
studies used adherence and the others used
compliance. However, among those studies, the
same measurement to measure variables of taking
medication was used.
Currently, since compliance and adherence have
different meanings, some authors have defined these
two terms. In terms of compliance, Vukovich (2010)
defined that compliance is a patient’s acceptance of
medication and other psychiatric treatment because
he/she is forced, persuaded, or pressured to take
his/her medication. In compliance, patients yield to or
obey to physicians’ instructions. It implies conformity
to medical defined goals only. Based on Seo and Min
(2005), compliance is more likely a person’s
behavior of taking medication in the correct dose,
and time as prescribed by the doctor. Based on Mullen
(as cited in Cohen, 2009), compliance implies
obedience and the expectation that patients will
passively follow the order. It refers to behavior
characterized by the extent to which people obey,
follow the instructions, or use the prescriptions
assigned by a health-care provider (Brawley &
Culos-Reed, 2000). Meanwhile, Patel and David
(2007) defined compliance is the extent to which a
person’s behavior coincides with medical advice. From
these definitions, it shows that compliance occurs
because of control or force by other people to follow
the prescriptions (external control), therefore, in this
condition, the patient is a passive patient.
Adherence, on the other hand, refers to patients’
voluntary behaviors to take their recommended
medication from their own commitment (Vukovich,
2010). Adherence is the patients’ choice to take their
medication under their own responsibility and they
can interpret their medication correctly because of
their understanding (Patel & David, 2007). It implies
that patients have their own choice to plan their
behavior to take medication and implement their
medication by their own motivation and action
(Brawley & Culos-Reed, 2000). Adherence is the
patient’s agreement to take medication and continue to
use it for a period of time (Velligan et al., 2006).
Patients’ attempts to maintain health behavior
related to behaviors to take their medication are
based on their active participation and agreement
(Cohen, 2009). Based on Lutfey and Whisner
(1999), adherence is the patients' behavior to take
their medication as independent, intelligent, and
autonomous people, therefore, the patients are
voluntary and become active participants in their
medical treatment. Furthermore, Horne (2006)
defined adherence as “the extent to which the patient’s