Introduction
The rate of psychological disorders continues to grow globally,
affecting millions of people worldwide. To have a deeper insight into
the proportions of specific psychological conditions, it has been
reported that 264 million people suffer from depression, 45 million from
bipolar disorder and 20 million from schizophrenia (1),(2). In Jordan,
the number of patients diagnosed with psychological disorders has not
been published, however, it was documented in a World Health
Organization (WHO) report that there are 64 mental health outpatient
facilities in Jordan, which provide services to an estimated 305 users
per 100,000 population, with the most commonly assigned diagnosis at
both outpatient facilities and mental hospitals being schizophrenia (3).
According to the WHO, Jordan has been identified as a country in need of
intense support for strengthening the mental health system (4). As is
the case all around the world, in Jordan, females suffer from
psychological conditions more than males (5),(6).
With the growing burden of psychiatric disorders worldwide, creating a
partnership relationship between patients and their healthcare
professionals is vital for proper management (7, 8). This can be done by
taking into consideration patients’ preferences, needs and values (7,
8). Hence, assessing patient’s beliefs and how it affects the management
of their condition would be useful (9).
Over the past years, the pharmacists’ role has developed to include
numerous patient-oriented clinical services (10). Being at the front
line, pharmacists have a unique position due to their direct contact
with patients (11). Hence, pharmacists can successfully identify
patients in need of help, including psychologically ill patients
hesitant to visit their specialist to get help (12-14).
In addition to their accessibility, the important role of the
pharmacists in the psychological healthcare sector was found to be
acknowledged by both healthcare professionals and patients around the
world (15). Pharmacists were found to enjoy a high level of patient
trust in Arab countries as well, including Jordan (13), assisting in
opportunistic screening for depression and anxiety (12).
Adherence to treatment is important for psychologically ill patients
considering the young age of the population, the high alert medications
used in their management (16), the side effects of treatment and
withdrawal symptoms due to misuse. Identifying barriers and relationship
of patient beliefs and values, and proper adherence can help in
optimizing the management of a culturally and religiously oriented group
of patients (17, 18).
Previous studies reported a positive effect of religious beliefs of
Muslims on coping with mental disorders and other distressing conditions
(19-22). However, the impact of religious beliefs on the perception of
psychiatric illnesses and adherence to medications by the Muslim
population has not been assessed as yet.
Culturally, perceived public mental illness stigma and self-stigma,
causes a delay in active help-seeking behavior (23). However, the size
of this stigma among patients who do seek help in the relatively
“closed” rural cultures and its effect on adherence has not been
evaluated.
In addition, several studies on patients with psychiatric disorders have
revealed overall high rates of perceived benefits of psychotherapeutic
interventions, including a study in Amman, the capital of Jordan, which
involved a sample of 100 patients who received psychosocial expert
interventions (23). No previous study, however, has evaluated the
awareness and preference of psychotherapy among patients with
psychiatric disorders in rural areas.
Although primary healthcare teams exist in rural areas to provide
services to chronically ill patients, including those diagnosed with
psychiatric disorders, barriers exist (15, 24). No previous study has
looked into the perspectives of patients with psychological illnesses
living in rural areas in Jordan when it comes to the management and
awareness of their condition, barriers to adherence, and the role of the
pharmacist.
This brings us to the aim of this study, which is to investigate
perspectives of patients diagnosed with psychiatric disorders, living in
rural areas in Jerash, Jordan, regarding their awareness about their
psychiatric conditions and their treatment, adherence to their
treatment, and related barriers, with special focus on the pharmacist’s
role.