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OBJECTIVE: Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia. METHODS: Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. RESULTS: 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02). CONCLUSION: The quality of doctor-patient communication also appears to influence adherence in schizophrenia. PRACTICE IMPLICATIONS: Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.

Original publication




Journal article


Patient Educ Couns

Publication Date





73 - 79


Adherence, Antipsychotics, Doctor–patient communication, Repair, Schizophrenia, Adult, Antipsychotic Agents, Cluster Analysis, Communication, Comprehension, Female, Humans, Male, Middle Aged, Patient Compliance, Physician-Patient Relations, Principal Component Analysis, Psychotherapy, Psychotic Disorders, Regression Analysis, Schizophrenia, Socioeconomic Factors, Time Factors, Video Recording