Explanatory Beliefs, Psychosocial Factors, and Medication Adherence among Adults Living with Schizophrenia in Zimbabwe

Medication adherence remains an important challenge in the long-term management of schizophrenia, particularly in settings where psychological, social and cultural factors may shape how people understand illness and treatment. Explanatory beliefs, social support and stigma may influence treatment-related behaviours, but evidence from Zimbabwe remains limited. This study examined the associations between explanatory beliefs, psychosocial factors and medication adherence among adults living with schizophrenia receiving outpatient psychiatric care in Zimbabwe. A cross-sectional quantitative study was conducted among 96 adults diagnosed with schizophrenia who were receiving outpatient psychiatric care. Participants completed measures assessing explanatory beliefs, medication adherence, perceived social support and stigma, while demographic and clinical information was also collected. Data were analysed using descriptive statistics, Pearson’s correlation coefficients and multiple linear regression. Medication non-adherence was common, with 59 participants (61.5%) classified as non-adherent and 37 (38.5%) classified as adherent. None of the explanatory belief domains, psychosocial variables or selected demographic and clinical variables showed a statistically significant correlation with medication adherence. In the multivariable regression model, the overall model was not statistically significant, F(8,87) = 1.58, p = .143, and explained 12.7% of the variance in medication adherence (adjusted R² = .047). Biological explanatory beliefs showed the strongest positive association with adherence (B = 0.498, β = .183, p = .076), although this did not reach statistical significance. The findings indicate that the explanatory and psychosocial variables examined in this study did not adequately explain variation in medication adherence in this sample. The relatively modest explanatory power of the regression model also suggests that other factors not examined here may contribute to medication-taking behaviour. The findings support the value of understanding medication adherence within the wider social and cultural context of psychiatric care, while highlighting the need for studies that directly measure broader dimensions of treatment engagement.