A mixed method evaluation of a medication concordance education programme for mental health nurses

Research Purpose: To ascertain whether nurses’ skill, self-efficacy and attitudes remain enhanced 8 months after a two-day Relapse Prevention (RP) and Medication Concordance (RPMC) training programme. Relevance: Patients relapse in high numbers due to poor concordance with medication regimes. An absence of evidence-based nurse training in medication concordance (MC) and RP contributes to these relapses, leading to high societal cost in relation to delayed discharge; early return to hospital or health centres; delays in return to work and increased resistance to drugs. Methods: A mixed method sequential design with some controls was employed. Participants were recruited from a large, mixed provision, NHS provider Trust. Some 21 nurses at Band 5/6 were recruited and divided into two groups to facilitate training. Each group was given two consecutive days of RPMC training supported by a comprehensive manual. The group was then assessed for changes in skill capability and self-efficacy at baseline (Point 1), 1 week post-RPMC training (Point 2) and at 8 months follow up (Point 3). Attitude changes were only measured at Point 1 and Point 3. Additionally, five participants were interviewed 10 weeks post-RPMC to gain insight into their actual MC and RP practice. Full ethics committee approval was obtained for this study. Results: A two-tailed Wilcoxon Rank test to measure within-group changes showed significant change in Skills Capability scores between Points 1 and 2 (p=0.002), but no significant difference between Points 2 and 3 (p=0.444). Self–efficacy scores showed equally significant changes between Points 1 and 2 (p=0.041); Point 2 (p=0.002) and Point 3 (p=0.05) Significant increase in self-efficacy was seen between Points 1 and Point 3 (p=0.026) as well as differences in attitude scores between Point 1 and Point 3 (p=0.007). The qualitative results showed the participants gained new insight and also improvement in their confidence, skills capability and attitude towards developing better understanding and partnership working to provide better choices for patients to take their medication. Conclusion: The RPMC two-day course improved skills capability, self-efficacy and attitudes of mental health nurses (MHNs) at an 8 months follow up. Implications: A Randomised Control Trial should now be conducted to assess whether these results are replicated and sustained among nurses and to improve MC capability in patients in Mental Health Services. Key words: Medication, concordance, adherence, compliance, skills, beliefs, attitudes and relapse prevention