Study of the factors influencing the non-adherence to treatment in a psychiatric population in Bingerville, Côte d'Ivoire

 Corresponding author: Niemtiah OUATTARA Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Study of the factors influencing the non-adherence to treatment in a psychiatric population in Bingerville, Côte d’Ivoire Niemtiah OUATTARA 1, *, Paterson Valery DISSEKA 2, Hounakey Mawunyo AFANVI 1, Yacouba OUATTARA 1, Romaric Taki YIAN 1 and Antoine Némé TAKO 1 1 Department of Applied Biology and Health, Faculty of Biosciences, Félix Houphouët-Boigny University, Abidjan, Côte d’Ivoire. 2 Laboratory of Human Movement, Development, and Well-Being Sciences, National Institute of Youth and Sports (INJS), Abidjan, Côte d'Ivoire. World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 Publication history: Received on 20 July 2025; revised on 26 August 2025; accepted on 30 August 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.27.2.2416 Abstract Background: Poor adherence to treatment is a worrying phenomenon that affects many patients worldwide. It can seriously compromise the effectiveness of treatment, leading to worsening symptoms, frequent hospitalizations and even reduced life expectancy. Objective: To identify factors leading to non-compliance with medication in psychiatric patients. Methods: This is a cross-sectional analytical study took place from 6 January to 3 February 2020 at Bingerville Psychiatric Hospital. It was conducted with 60 patients. Sociodemographic data was collected from patients using their medical records. Medication adherence was assessed using Thompson's MARS (Medication Adherence Rating Scale). Results: Patients with a secondary education were the least compliant (61.90%), followed by those with a university education (16.67%) and those with no education (11.90%). Patients with primary education were the least compliant, at 9.52%. These differences are not significant (X² = 1.15, p = 0.2827). Of the 42 non-compliant patients, 61.90% were unemployed (26 cases). 4.76% were civil servants, 2.38% were self-employed and 30.95% worked in other sectors. These differences are not statistically significant (X² = 1.15, p = 0.2827). Among the non-respondents, 88.10% were single, 7.14% were cohabiting, or married and 2.38% were divorced or widowed. These differences are significant (X²= 15.78, p= 0.0001). Conclusion: To improve the monitoring of psychiatric treatment in Côte d'Ivoire, a larger sample size should be included, and the questionnaires should be adapted to reflect African realities. This should consider socio-demographic, ethno-social and spiritual factors. Studies could also explore the relationship between the type of disorder and the therapeutic alliance. Keywords: Psychiatry Population; Poor Compliance; Therapeutic Treatments; Population in Bingerville; Côte d'Ivoire World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2145 1. Introduction Poor medication adherence, also known as therapeutic non-adherence, refers to the failure to comply with medical treatments, which can have serious health consequences. In psychiatry, as in other medical disciplines, non-adherence by patients is one of the main barriers to controlling their disorders. Many studies have shown that poor medication adherence in patients with psychiatric disorders is a problem with many parameters [1]. An average medication adherence rate of 50% is classically found in the literature [2]. Medication adherence rates vary depending on the type of disease. Some patients with chronic conditions such as diabetes or hypertension may have higher adherence rates than those with more acute conditions [3]. It is a public health problem [4] because it significantly increases the length of hospital stay, but also the rate of relapse and rehospitalization [5]. In this context, it is essential to understand and situate behaviors such as non-adherence within a multifactorial system and complex relationships to best achieve the goals of the health sciences. Numerous experimental and observational studies, mainly in developed countries, have demonstrated the importance of compliance as a major factor in therapeutic efficacy [6] . Non-compliance can sometimes have positive short-term effects for the patient, such as the disappearance of side effects or a reduction in drug-related costs. However, from a medical point of view, it can lead to the loss of immediate and long-term benefits, such as the recurrence of symptoms, the occurrence of complications, the risk of relapse and the emergence of resistance, as well as an increase in rehospitalisations. Numerous experimental and observational studies, mainly in developed countries, have demonstrated the importance of compliance as a major factor in therapeutic efficacy [6]. In addition, taking or not taking medication can become a matter of negotiation for patients, giving them a sense of power and social benefits. In economic terms, the impact is measured in terms of direct costs associated with care, indirect costs (time off work due to deterioration in health) and intangible costs (deterioration in perceived health). In addition, economic losses due to reduced productivity and absenteeism can also be significant. It is therefore crucial to consider the total economic impact of health problems to implement effective prevention policies and ensure a sustainable health system [7] [8]. In addition, taking or not taking medication can become a matter of negotiation for patients, giving them a sense of power and social benefits. In economic terms, the impact is measured in terms of direct costs associated with care, indirect costs (time off work due to deterioration in health) and intangible costs (deterioration in perceived health). In addition, economic losses due to reduced productivity and absenteeism can also be significant. It is therefore crucial to consider the total economic impact of health problems to implement effective prevention policies and ensure a sustainable health system [9] [10]. In changing societies like Côte d'Ivoire, the risk has increased. The places and causes of crises are many and varied. The sick are increasingly children, adolescents, adults, women, men, immigrants, indigenous people, illiterates, schoolchildren. Modern doctors, traditional healers, diviners, religious people and herbalists provide mental health care. In this context, our study has highlighted the factors that lead to poor adherence to medication among psychiatric patients. The specific objectives of this study were to describe the socio-demographic characteristics of the patients studied, to assess patient compliance using the MARS questionnaire and, finally, to establish the relationship between the socio-demographic characteristics of the patients and their level of compliance using bivariate analysis. 2. Materials and methods 2.1. Setting of the study Our study took place in the mental health unit of the Bingerville Psychiatric Hospital, a community on the outskirts of Abidjan. Bingerville Psychiatric Hospital is the leading psychiatric institution in Côte d'Ivoire. 2.2. Study subjects The subjects of our study were psychiatric patients. Included in the study were stabilized patients, men or women aged 18 years or older, consenting to the study, outpatients and inpatients on at least their second admission to the Bingerville Psychiatric Hospital. Excluded from the study were non-stabilized patients, patients who did not consent to the study, patients who had never been hospitalized and patients who were on first admission to the Bingerville Psychiatric Hospital. World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2146 2.3. Data collection material The technical material used to collect the data was a survey form, but the patients' medical records were also consulted. 2.4. Survey form The survey form was designed in three parts (Appendix 1): -First, the first part of the form allowed us to collect socio-demographic information about the patients (sex, age, ethnic group, level of education, occupational and marital status), but also information about their current treatments and dosages. -The second part is the 10-item MARS questionnaire, translated into French from the original English version by Thompson et al. (2000). It is a self-report questionnaire with two possible answers: "YES" or "NO". The questions relate on the one hand to the patients' behavior about their treatment and on the other hand to their subjective perception of the treatment. The advantages are speed of administration and ease of use in both clinical and research settings. This questionnaire groups its items into three main components, which are: • The behavioral component of compliance (items 1, 2, 3, and 4); • The patient's attitude towards taking medication (items 5, 6, 7, and 8); • The side effects associated with the patient's attitude towards psychotropic medication (items 9 and 10). The items are scored 1 for a 'NO' response and 0 for a 'YES' response, except for items 7 and 8 which are scored 0 for a 'NO' response and 1 for a 'YES' response. The total score ranges from 0 to 10. The higher the score, the more compliant the patient is with their treatment; a total score below 5 indicates non-compliant patients. -The third part is a hetero-questionnaire that lists the most common reasons for poor adherence or discontinuation. As in the first questionnaire, there are two possible answers: "YES" or "NO". The answers collected give an idea of the reasons why a patient may not adhere to their treatment. 2.5. Medical records Medical records were consulted to obtain further information (examination results, consultation and hospitalisation reports, therapeutic prescriptions carried out, etc.) on hospitalised patients. 2.6. Methods This is a cross-sectional study with an analytical objective that took place from 6 January to 3 February 2020 at the Bingerville Psychiatric Hospital. It was carried out in the HPB archives and involved 60 patients selected based on whether they were inpatients or outpatients. To be included in the study, it was not necessary for the interned patients to be at the hospital for the first time because, as they were interned, the nurses were responsible for their medication. Using an invitation form (Appendix 2), all patients were given a brief presentation of the study before giving their consent. Subjects of both sexes were selected. We administered the different questionnaires to them, starting by collecting some socio-demographic information (age, sex, and ethnic group, professional and marital status). We also looked at the patients' most recent medical prescriptions to find out what treatment they were taking and how much they were taking. They were then given the first questionnaire (MARS test), which makes it possible to distinguish between compliant and non-compliant patients. Finally, they were given the second questionnaire, which lists the most common reasons for poor follow-up or discontinuation of treatment. The interviews with the patients took place in a room and all their answers were collected in the absence of the treating staff, to avoid any influence on their part. The questions were closed, their completion was based on the patients' answers, and they had the choice between two answers "YES" or "NO". 2.7. Collected data The data collected was processed using software (Word, Excel and Statistica). Excel was used to make graphs and crossreferences between socio-demographic parameters and compliance; the significance of the cross-references made was verified with Statistica software. Chi ² (X²) was used for this purpose. If X² < 4, the difference is not significant; if X² ≥ 4, the difference is significant, and the significance level p is less than or equal to 0.05. World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2147 3. Results 3.1. Socio-demographic data 3.1.1. Gender The two sexes were represented and distributed as follows: 53% male patients and 47%female patients (Figure1) Figure 1 Sample distribution by gender 3.1.2. Patient age The average age of the patients was 33 years, with extremes ranging from 17 to 66 years. The patients could be divided into 3 age groups: adolescents (under 18years), young people (18 to 40 years) and adults (over 40years). Adolescents predominated with a percentage of 88.33%. Adults represented 10% of the sample. The adolescent class had only one case or 1.67% of the sample (Figure 2). Figure 2 Distribution of the sample by age group 3.1.3. Ethnic groups The patients were divided into two categories according to their ethnicity (Figure 3). The patients, representing 83.33% of the sample, were divided into 4 ethnic groups (Akan, Gur, Krou and Mande). The Akan were in the majority with 22 representatives. The Gur had only 5 representatives. The Krou had 11 patients. There were 15 Mande patients. The minority was represented by non-Ivorian patients, who numbered 7, i.e. 11.67% of the sample. World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2148 Figure 3 Sample distribution by ethnic group 3.1.4. Educational level In the sample, 11.67% of patients had never been to school. 13.33% had primary education, 25% and 31.67% had lower and upper secondary education respectively. Patients with university education represented 18.33% of the sample (Figure 4). Figure 4 Distribution of the sample according to level of study 3.1.5. Employment status 63% of the patients were unemployed, 7% were civil servants, 3% were self-employed and 27% were in other occupations (Figure 5) World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2149 Figure 5 Distribution of the sample according to professional situation 3.1.6. Marital status Single patients represented most of the sample with a rate of 86.67%. Only 10% of the patients were married (6 cases). There was only 1 divorced patient and 1 widowed patient (Figure 6). Figure 6 Sample distribution by marital status 3.2. Compliance according to questionnaires 3.2.1. Compliance according to the MARS questionnaire According to the MARS questionnaire, our sample was distributed with a clear predominance of non-compliant patients. In fact, 70% of the study population had a general score of less than 5 and were considered non-compliant. Compliant patients represented only 30% of the study population, with a general score of 5 or higher (Figure 7). World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2150 Figure 7 Results of compliance assesement using the MARS questionnaire 3.2.2. Reasons for non-compliance according to the MARS questionnaire The assessment of compliance showed that 7/10 of the patients, or 42 of the 60 patients studied, were not compliant with their treatment, with a general score of less than 5. In general, the population studied was non-compliant with their treatment, with an average score of 4.683. According to Table I, more than 2/3 of these patients cited the following as the main reasons for non-compliance: experiencing side effects after taking their medication, refusing to let their body and mind be controlled by their medication, and forgetfulness. Table 1 MARS self-assessment questionnaire World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2151 3.2.3. Reasons for non-adherence according to the Hetero questionnaire In addition to some of the reasons already mentioned in the MARS questionnaire, the hetero questionnaire (Table II) showed that a large majority of patients did not adhere well to their treatment for the following reasons: the effects of drowsiness and fatigue induced by psychotropic drugs, which prevent them from working or attending normal classes, and the high cost of certain drugs. Patients added to these factors the fact that long-term medication is very tiring and painful, the fact that they do not consider themselves to be ill, and the fear of becoming dependent on medication. Table 2 Hetero questionnaire of the cause of poor treatment monitoring World Journal of Advanced Research and Reviews, 2025, 27(02), 2144-2156 2152 3.2.4. Compliance by socio-demographic parameters Cross-sectional relationship between gender and poor compliance Both sexes had approximately the same level of noncompliance. Of the 42 non-compliant patients, 52% were men and 48% were women, i.e. 22 and 20 cases of non-compliance were observed in men and women respectively (Figure 8). This difference is not significant as X²= 0.00 < 4 and p= 0.9498 ˃ 0.05. Figure 8 Relationship between gender and poor complaince Correlation between age group and poor compliance Non-compliance is more common among young people (18 to 40 years old), who account for 85.71% of cases. Adults (41 to 66 years old) follow them, who account for 14.29% of cases of non-compliance. The juvenile category was not considered because of the single case representing it (Figure 9). This difference is significant as X² = 13.67 ˃ 4 and p = 0.0002 < 0.05.