Macdonald, LA; (2017) Medication adherence in bipolar disorder: Understanding patients’ perspectives to inform intervention development. Doctoral thesis , UCL (University College London).

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Abstract

Bipolar Disorder is primarily treated with medication which can be effective in reducing relapse risk, however, treatment is complex and adherence is sub-optimal. People can face significant challenges in self-managing the condition. The aim of this thesis was to better understand patients’ perspectives of BD and its treatment. Then, to use both this knowledge and self-regulation and behaviour change theory to develop and test a novel intervention entitled Improving information for people with Bipolar Disorder (IBiD). Intervention mapping, a stepwise process was followed to develop intervention content, delivery and evaluation. A systematic review with meta-analysis (k=18) was conducted and revealed that interventions are effective in improving adherence, effects are durable and brief interventions may be more effective than longer programmes (Chapter 3). A qualitative study (Chapter 4) (n=12) revealed patients insights into the burden of illness, unmet information needs and also how to live well with BD. These findings informed the IBiD intervention, which was tested in a feasibility RCT in a sample of patients in an acute mental health setting (Chapters 5-7). The intervention can feasibly be delivered in this setting and was acceptable to patients. Aspects of the intervention and the study itself had self-reported positive outcomes, however a more targeted, longer intervention may be required to actually modify specific medication beliefs and adherence. In order to explore additional factors raised during these studies a cross-sectional study (n=57) into the associations between perceptions, adherence and involvement in treatment decisions was conducted. Experiences of involvement and preferences for this were high. Involvement was significantly associated with satisfaction with information and illness perceptions. Associations between involvement and adherence were inconsistent. The results of this research programme have important implications for both mental health services and the application of health and illness theory to mental health.

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