Co esponding au ho : Niem iah OUATTARA
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
S udy o he ac o s in luencing he non-adhe ence o ea men in a psychia ic
popula ion in Binge ille, Cô e d’I oi e
Niem iah OUATTARA 1, *, Pa e son Vale y DISSEKA 2, Hounakey Mawunyo AFANVI 1, Yacouba OUATTARA 1,
Roma ic Taki YIAN 1 and An oine Némé TAKO 1
1 Depa men o Applied Biology and Heal h, Facul y o Biosciences, Félix Houphouë -Boigny Uni e si y, Abidjan, Cô e
d’I oi e.
2 Labo a o y o Human Mo emen , De elopmen , and Well-Being Sciences, Na ional Ins i u e o You h and Spo s (INJS),
Abidjan, Cô e d'I oi e.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 2144-2156
Publica ion his o y: Recei ed on 20 July 2025; e ised on 26 Augus 2025; accep ed on 30 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2416
Abs ac
Backg ound: Poo adhe ence o ea men is a wo ying phenomenon ha a ec s many pa ien s wo ldwide. I can
se iously comp omise he e ec i eness o ea men , leading o wo sening symp oms, equen hospi aliza ions and
e en educed li e expec ancy.
Objec i e: To iden i y ac o s leading o non-compliance wi h medica ion in psychia ic pa ien s.
Me hods: This is a c oss-sec ional analy ical s udy ook place om 6 Janua y o 3 Feb ua y 2020 a Binge ille
Psychia ic Hospi al. I was conduc ed wi h 60 pa ien s.
Sociodemog aphic da a was collec ed om pa ien s using hei medical eco ds. Medica ion adhe ence was assessed
using Thompson's MARS (Medica ion Adhe ence Ra ing Scale).
Resul s: Pa ien s wi h a seconda y educa ion we e he leas complian (61.90%), ollowed by hose wi h a uni e si y
educa ion (16.67%) and hose wi h no educa ion (11.90%). Pa ien s wi h p ima y educa ion we e he leas complian ,
a 9.52%. These di e ences a e no signi ican (X² = 1.15, p = 0.2827). O he 42 non-complian pa ien s, 61.90% we e
unemployed (26 cases). 4.76% we e ci il se an s, 2.38% we e sel -employed and 30.95% wo ked in o he sec o s.
These di e ences a e no s a is ically signi ican (X² = 1.15, p = 0.2827). Among he non- esponden s, 88.10% we e
single, 7.14% we e cohabi ing, o ma ied and 2.38% we e di o ced o widowed. These di e ences a e signi ican (X²=
15.78, p= 0.0001).
Conclusion: To imp o e he moni o ing o psychia ic ea men in Cô e d'I oi e, a la ge sample size should be
included, and he ques ionnai es should be adap ed o e lec A ican eali ies. This should conside socio-demog aphic,
e hno-social and spi i ual ac o s. S udies could also explo e he ela ionship be ween he ype o diso de and he
he apeu ic alliance.
Keywo ds: Psychia y Popula ion; Poo Compliance; The apeu ic T ea men s; Popula ion in Binge ille; Cô e d'I oi e
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1. In oduc ion
Poo medica ion adhe ence, also known as he apeu ic non-adhe ence, e e s o he ailu e o comply wi h medical
ea men s, which can ha e se ious heal h consequences. In psychia y, as in o he medical disciplines, non-adhe ence
by pa ien s is one o he main ba ie s o con olling hei diso de s. Many s udies ha e shown ha poo medica ion
adhe ence in pa ien s wi h psychia ic diso de s is a p oblem wi h many pa ame e s [1]. An a e age medica ion
adhe ence a e o 50% is classically ound in he li e a u e [2]. Medica ion adhe ence a es a y depending on he ype
o disease. Some pa ien s wi h ch onic condi ions such as diabe es o hype ension may ha e highe adhe ence a es
han hose wi h mo e acu e condi ions [3].
I is a public heal h p oblem [4] because i signi ican ly inc eases he leng h o hospi al s ay, bu also he a e o elapse
and ehospi aliza ion [5]. In his con ex , i is essen ial o unde s and and si ua e beha io s such as non-adhe ence
wi hin a mul i ac o ial sys em and complex ela ionships o bes achie e he goals o he heal h sciences.
Nume ous expe imen al and obse a ional s udies, mainly in de eloped coun ies, ha e demons a ed he impo ance
o compliance as a majo ac o in he apeu ic e icacy [6] . Non-compliance can some imes ha e posi i e sho - e m
e ec s o he pa ien , such as he disappea ance o side e ec s o a educ ion in d ug- ela ed cos s. Howe e , om a
medical poin o iew, i can lead o he loss o immedia e and long- e m bene i s, such as he ecu ence o symp oms,
he occu ence o complica ions, he isk o elapse and he eme gence o esis ance, as well as an inc ease in
ehospi alisa ions. Nume ous expe imen al and obse a ional s udies, mainly in de eloped coun ies, ha e
demons a ed he impo ance o compliance as a majo ac o in he apeu ic e icacy [6]. In addi ion, aking o no aking
medica ion can become a ma e o nego ia ion o pa ien s, gi ing hem a sense o powe and social bene i s. In
economic e ms, he impac is measu ed in e ms o di ec cos s associa ed wi h ca e, indi ec cos s ( ime o wo k due
o de e io a ion in heal h) and in angible cos s (de e io a ion in pe cei ed heal h). In addi ion, economic losses due o
educed p oduc i i y and absen eeism can also be signi ican . I is he e o e c ucial o conside he o al economic
impac o heal h p oblems o implemen e ec i e p e en ion policies and ensu e a sus ainable heal h sys em [7] [8]. In
addi ion, aking o no aking medica ion can become a ma e o nego ia ion o pa ien s, gi ing hem a sense o powe
and social bene i s. In economic e ms, he impac is measu ed in e ms o di ec cos s associa ed wi h ca e, indi ec
cos s ( ime o wo k due o de e io a ion in heal h) and in angible cos s (de e io a ion in pe cei ed heal h). In addi ion,
economic losses due o educed p oduc i i y and absen eeism can also be signi ican . I is he e o e c ucial o conside
he o al economic impac o heal h p oblems o implemen e ec i e p e en ion policies and ensu e a sus ainable heal h
sys em [9] [10]. In changing socie ies like Cô e d'I oi e, he isk has inc eased. The places and causes o c ises a e many
and a ied. The sick a e inc easingly child en, adolescen s, adul s, women, men, immig an s, indigenous people,
illi e a es, schoolchild en. Mode n doc o s, adi ional heale s, di ine s, eligious people and he balis s p o ide men al
heal h ca e.
In his con ex , ou s udy has highligh ed he ac o s ha lead o poo adhe ence o medica ion among psychia ic
pa ien s. The speci ic objec i es o his s udy we e o desc ibe he socio-demog aphic cha ac e is ics o he pa ien s
s udied, o assess pa ien compliance using he MARS ques ionnai e and, inally, o es ablish he ela ionship be ween
he socio-demog aphic cha ac e is ics o he pa ien s and hei le el o compliance using bi a ia e analysis.
2. Ma e ials and me hods
2.1. Se ing o he s udy
Ou s udy ook place in he men al heal h uni o he Binge ille Psychia ic Hospi al, a communi y on he ou ski s o
Abidjan. Binge ille Psychia ic Hospi al is he leading psychia ic ins i u ion in Cô e d'I oi e.
2.2. S udy subjec s
The subjec s o ou s udy we e psychia ic pa ien s. Included in he s udy we e s abilized pa ien s, men o women aged
18 yea s o olde , consen ing o he s udy, ou pa ien s and inpa ien s on a leas hei second admission o he
Binge ille Psychia ic Hospi al.
Excluded om he s udy we e non-s abilized pa ien s, pa ien s who did no consen o he s udy, pa ien s who had ne e
been hospi alized and pa ien s who we e on i s admission o he Binge ille Psychia ic Hospi al.
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2.3. Da a collec ion ma e ial
The echnical ma e ial used o collec he da a was a su ey o m, bu he pa ien s' medical eco ds we e also consul ed.
2.4. Su ey o m
The su ey o m was designed in h ee pa s (Appendix 1):
-Fi s , he i s pa o he o m allowed us o collec socio-demog aphic in o ma ion abou he pa ien s (sex, age, e hnic
g oup, le el o educa ion, occupa ional and ma i al s a us), bu also in o ma ion abou hei cu en ea men s and
dosages.
-The second pa is he 10-i em MARS ques ionnai e, ansla ed in o F ench om he o iginal English e sion by
Thompson e al. (2000). I is a sel - epo ques ionnai e wi h wo possible answe s: "YES" o "NO". The ques ions ela e
on he one hand o he pa ien s' beha io abou hei ea men and on he o he hand o hei subjec i e pe cep ion o
he ea men . The ad an ages a e speed o adminis a ion and ease o use in bo h clinical and esea ch se ings. This
ques ionnai e g oups i s i ems in o h ee main componen s, which a e:
• The beha io al componen o compliance (i ems 1, 2, 3, and 4);
• The pa ien 's a i ude owa ds aking medica ion (i ems 5, 6, 7, and 8);
• The side e ec s associa ed wi h he pa ien 's a i ude owa ds psycho opic medica ion (i ems 9 and 10).
The i ems a e sco ed 1 o a 'NO' esponse and 0 o a 'YES' esponse, excep o i ems 7 and 8 which a e sco ed 0 o a
'NO' esponse and 1 o a 'YES' esponse. The o al sco e anges om 0 o 10. The highe he sco e, he mo e complian
he pa ien is wi h hei ea men ; a o al sco e below 5 indica es non-complian pa ien s.
-The hi d pa is a he e o-ques ionnai e ha lis s he mos common easons o poo adhe ence o discon inua ion. As
in he i s ques ionnai e, he e a e wo possible answe s: "YES" o "NO". The answe s collec ed gi e an idea o he
easons why a pa ien may no adhe e o hei ea men .
2.5. Medical eco ds
Medical eco ds we e consul ed o ob ain u he in o ma ion (examina ion esul s, consul a ion and hospi alisa ion
epo s, he apeu ic p esc ip ions ca ied ou , e c.) on hospi alised pa ien s.
2.6. Me hods
This is a c oss-sec ional s udy wi h an analy ical objec i e ha ook place om 6 Janua y o 3 Feb ua y 2020 a he
Binge ille Psychia ic Hospi al. I was ca ied ou in he HPB a chi es and in ol ed 60 pa ien s selec ed based on
whe he hey we e inpa ien s o ou pa ien s. To be included in he s udy, i was no necessa y o he in e ned pa ien s
o be a he hospi al o he i s ime because, as hey we e in e ned, he nu ses we e esponsible o hei medica ion.
Using an in i a ion o m (Appendix 2), all pa ien s we e gi en a b ie p esen a ion o he s udy be o e gi ing hei
consen . Subjec s o bo h sexes we e selec ed. We adminis e ed he di e en ques ionnai es o hem, s a ing by
collec ing some socio-demog aphic in o ma ion (age, sex, and e hnic g oup, p o essional and ma i al s a us). We also
looked a he pa ien s' mos ecen medical p esc ip ions o ind ou wha ea men hey we e aking and how much
hey we e aking. They we e hen gi en he i s ques ionnai e (MARS es ), which makes i possible o dis inguish
be ween complian and non-complian pa ien s. Finally, hey we e gi en he second ques ionnai e, which lis s he mos
common easons o poo ollow-up o discon inua ion o ea men . The in e iews wi h he pa ien s ook place in a
oom and all hei answe s we e collec ed in he absence o he ea ing s a , o a oid any in luence on hei pa . The
ques ions we e closed, hei comple ion was based on he pa ien s' answe s, and hey had he choice be ween wo
answe s "YES" o "NO".
2.7. Collec ed da a
The da a collec ed was p ocessed using so wa e (Wo d, Excel and S a is ica). Excel was used o make g aphs and c oss-
e e ences be ween socio-demog aphic pa ame e s and compliance; he signi icance o he c oss- e e ences made was
e i ied wi h S a is ica so wa e. Chi ² (X²) was used o his pu pose. I X² < 4, he di e ence is no signi ican ; i X² ≥ 4,
he di e ence is signi ican , and he signi icance le el p is less han o equal o 0.05.
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3. Resul s
3.1. Socio-demog aphic da a
3.1.1. Gende
The wo sexes we e ep esen ed and dis ibu ed as ollows: 53% male pa ien s and 47% emale pa ien s (Figu e1)
Figu e 1 Sample dis ibu ion by gende
3.1.2. Pa ien age
The a e age age o he pa ien s was 33 yea s, wi h ex emes anging om 17 o 66 yea s. The pa ien s could be di ided
in o 3 age g oups: adolescen s (unde 18yea s), young people (18 o 40 yea s) and adul s (o e 40yea s). Adolescen s
p edomina ed wi h a pe cen age o 88.33%. Adul s ep esen ed 10% o he sample. The adolescen class had only one
case o 1.67% o he sample (Figu e 2).
Figu e 2 Dis ibu ion o he sample by age g oup
3.1.3. E hnic g oups
The pa ien s we e di ided in o wo ca ego ies acco ding o hei e hnici y (Figu e 3). The pa ien s, ep esen ing 83.33%
o he sample, we e di ided in o 4 e hnic g oups (Akan, Gu , K ou and Mande). The Akan we e in he majo i y wi h 22
ep esen a i es. The Gu had only 5 ep esen a i es. The K ou had 11 pa ien s. The e we e 15 Mande pa ien s. The
mino i y was ep esen ed by non-I o ian pa ien s, who numbe ed 7, i.e. 11.67% o he sample.
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Figu e 3 Sample dis ibu ion by e hnic g oup
3.1.4. Educa ional le el
In he sample, 11.67% o pa ien s had ne e been o school. 13.33% had p ima y educa ion, 25% and 31.67% had lowe
and uppe seconda y educa ion espec i ely. Pa ien s wi h uni e si y educa ion ep esen ed 18.33% o he sample
(Figu e 4).
Figu e 4 Dis ibu ion o he sample acco ding o le el o s udy
3.1.5. Employmen s a us
63% o he pa ien s we e unemployed, 7% we e ci il se an s, 3% we e sel -employed and 27% we e in o he
occupa ions (Figu e 5)
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Figu e 5 Dis ibu ion o he sample acco ding o p o essional si ua ion
3.1.6. Ma i al s a us
Single pa ien s ep esen ed mos o he sample wi h a a e o 86.67%. Only 10% o he pa ien s we e ma ied (6 cases).
The e was only 1 di o ced pa ien and 1 widowed pa ien (Figu e 6).
Figu e 6 Sample dis ibu ion by ma i al s a us
3.2. Compliance acco ding o ques ionnai es
3.2.1. Compliance acco ding o he MARS ques ionnai e
Acco ding o he MARS ques ionnai e, ou sample was dis ibu ed wi h a clea p edominance o non-complian pa ien s.
In ac , 70% o he s udy popula ion had a gene al sco e o less han 5 and we e conside ed non-complian . Complian
pa ien s ep esen ed only 30% o he s udy popula ion, wi h a gene al sco e o 5 o highe (Figu e 7).
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Figu e 7 Resul s o compliance assesemen using he MARS ques ionnai e
3.2.2. Reasons o non-compliance acco ding o he MARS ques ionnai e
The assessmen o compliance showed ha 7/10 o he pa ien s, o 42 o he 60 pa ien s s udied, we e no complian
wi h hei ea men , wi h a gene al sco e o less han 5. In gene al, he popula ion s udied was non-complian wi h hei
ea men , wi h an a e age sco e o 4.683. Acco ding o Table I, mo e han 2/3 o hese pa ien s ci ed he ollowing as
he main easons o non-compliance: expe iencing side e ec s a e aking hei medica ion, e using o le hei body
and mind be con olled by hei medica ion, and o ge ulness.
Table 1 MARS sel -assessmen ques ionnai e
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3.2.3. Reasons o non-adhe ence acco ding o he He e o ques ionnai e
In addi ion o some o he easons al eady men ioned in he MARS ques ionnai e, he he e o ques ionnai e (Table II)
showed ha a la ge majo i y o pa ien s did no adhe e well o hei ea men o he ollowing easons: he e ec s o
d owsiness and a igue induced by psycho opic d ugs, which p e en hem om wo king o a ending no mal classes,
and he high cos o ce ain d ugs. Pa ien s added o hese ac o s he ac ha long- e m medica ion is e y i ing and
pain ul, he ac ha hey do no conside hemsel es o be ill, and he ea o becoming dependen on medica ion.
Table 2 He e o ques ionnai e o he cause o poo ea men moni o ing
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3.2.4. Compliance by socio-demog aphic pa ame e s
C oss-sec ional ela ionship be ween gende and poo compliance
Bo h sexes had app oxima ely he same le el o noncompliance. O he 42 non-complian pa ien s, 52% we e men and
48% we e women, i.e. 22 and 20 cases o non-compliance we e obse ed in men and women espec i ely (Figu e 8).
This di e ence is no signi ican as X²= 0.00 < 4 and p= 0.9498 ˃ 0.05.
Figu e 8 Rela ionship be ween gende and poo complaince
Co ela ion be ween age g oup and poo compliance
Non-compliance is mo e common among young people (18 o 40 yea s old), who accoun o 85.71% o cases. Adul s
(41 o 66 yea s old) ollow hem, who accoun o 14.29% o cases o non-compliance. The ju enile ca ego y was no
conside ed because o he single case ep esen ing i (Figu e 9). This di e ence is signi ican as X² = 13.67 ˃ 4 and p =
0.0002 < 0.05.
