Medication adherence mediates the association between illness perceptions and psychotic symptoms in patients with schizophrenia.

OBJECTIVE: To investigate whether the knowledge, attitude, and behavior dimensions of medication adherence mediate the associations between illness perceptions and psychotic symptoms in patients with schizophrenia. METHODS: This cross-sectional study recruited 142 patients with schizophrenia who had stable symptom control from a regional teaching hospital in southern Taiwan. Standardized instruments were used to assess illness perceptions, medication knowledge, attitudes, behaviors, and psychotic symptoms. Simple mediation analyses were conducted using the PROCESS macro in SPSS. RESULTS: Medication adherence attitudes and behaviors mediated the associations between several illness perception dimensions, including illness identity, timeline acute/chronic, personal control, treatment control, and psychotic symptoms; however, emotional representation was mediated only through medication adherence behavior. Medication knowledge demonstrated a ceiling effect and did not meet the statistical prerequisites for mediation. CONCLUSION: Addressing illness perceptions through interventions that target medication adherence attitudes and behaviors may improve medication adherence and reduce psychotic symptoms in patients with schizophrenia. Nursing interventions should move beyond knowledge provision alone and address patients' subjective illness beliefs. For patients with prominent emotional distress, behavior-focused supports such as environmental reminders or simplification of medication routines may be particularly important for stabilizing medication adherence.