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.