CORRELATES OF MEDICATION DECISION SELF-EFFICACY AMONG ADOLESCENTS IN PSYCHIATRIC RESIDENTIAL FACILITIES

Purpose:

Little is known about how to improve adherence to psychotropic medication among children and adolescents. However, improving self-efficacy is posited as a central mechanism of a larger theoretical framework for understanding how to increase medication adherence for adults with chronic mental illness (McCann et al., 2008). Results are mixed regarding the effectiveness of medication adherence interventions which employ a range of educational, cognitive, and behavioral approaches (Dean et al., 2010) and highlight the need for better understanding of how these approaches impact self-efficacy and how this may or may not relate to medication adherence.  The purpose of the current study is to explore the relationship of medication knowledge, beliefs, and attitudes to self-efficacy about participating in medication management.

Method:

Data were collected from 109 adolescent residents (mean 14.8 years, SD = 1.4) of a psychiatric residential treatment facilities in Midwestern United States. Knowledge of current medication, attitudes toward medication, concerns about participating, and decision self-efficacy were assessed with paper-and-pencil instruments administered by research staff and facility nurses. Hierarchical regression models were run to examine the independent contribution of each construct on decision self-efficacy, controlling for demographics and diagnosis.

Result:

Overall, as measured, the 3 constructs accounted for 53% of the variance in decision self-efficacy. Positive attitudes toward medication had the strongest association with decision self-efficacy even after controlling for concerns about participating, medication knowledge, demographics, and diagnosis (β = 0.494, p<.001). Concerns about participating and medication knowledge also independently contributed to increased decision self-efficacy (β = 0.19 and β = 0.20, p < .05 respectively).

Conclusion:

Among adolescents in this study, beliefs of self-efficacy, or confidence in one’s ability to engage in medication decisions, was significantly predicted by positive attitudes toward medication and knowledge about one’s medication regardless of age, race, gender, or primary diagnosis. Interestingly, adolescents who expressed concerns about participating also appeared to hold greater beliefs of self-efficacy. This may be reflective of an overall interest and investment in one’s own treatment planning where “concerns” should not be construed as negative cognitions.  Future studies should focus on how improving medication attitudes and increasing medication knowledge might increase self-efficacy and how this ultimately relates to improved participation in treatment planning and medication adherence.