Project – The Effect of Nurse Communication on Medication Adherence among Patients Attending Outpatient Clinics: A Study of Selected Hospitals in Enugu State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Medication adherence is an important component of effective healthcare because the benefits of appropriately prescribed medicines depend substantially on whether patients take them according to the agreed treatment plan. The World Health Organization (WHO) defines adherence as the extent to which a person’s behaviour in taking medication, following a diet or making lifestyle changes corresponds with recommendations agreed upon with a healthcare provider. The WHO further explains that poor adherence to long-term therapies is a major problem across different health conditions and healthcare settings and that adherence is influenced by multiple factors involving the patient, treatment, health condition, socioeconomic circumstances and healthcare system. Consequently, medication adherence should not be understood simply as a matter of patient willingness or forgetfulness but as a complex behaviour that can also be influenced by the interaction between patients and healthcare professionals (World Health Organization [WHO], 2003).

Communication between healthcare professionals and patients is an important element of patient-centred care because patients require understandable and relevant information to make informed decisions about their treatment. Effective communication can involve explaining the purpose of medication, dosage and timing, possible adverse effects, precautions and the importance of completing or continuing treatment as prescribed. Recent systematic evidence has examined the relationship between healthcare practitioner communication and patient adherence, indicating that communication is an important area of investigation even though the strength of evidence varies according to study design and clinical context. A 2026 systematic review identified 24 eligible studies involving 8,671 patients and found evidence of a positive relationship between communication and adherence in observational studies, while noting greater uncertainty in the randomised-trial evidence (Keshtkar et al., 2026).

Nurses occupy an important position in patient communication because they frequently interact with patients during assessment, treatment, health education, medication administration and follow-up care. In outpatient settings, nurses may explain medication instructions, reinforce information provided by physicians, respond to patient concerns and identify difficulties that could affect treatment adherence. A 2024 scoping review of therapeutic communication between nurses and patients in Africa found that effective therapeutic communication is associated with patient care and wellbeing, while identifying barriers that can interfere with communication between nurses and patients. The African context is particularly relevant because communication can be affected by language differences, cultural expectations, workload, health literacy and the organisation of healthcare services (Abraham et al., 2024).

The quality of nurse–patient communication may influence patients’ understanding of their medications and their confidence in carrying out treatment instructions. When medication information is presented clearly and patients are encouraged to ask questions, misunderstandings concerning dosage, timing, duration and possible side effects may be reduced. Conversely, inadequate explanations or limited opportunities for patients to clarify their concerns may contribute to uncertainty about treatment. Evidence from a 2025 systematic review of communication strategies for improving medication adherence among patients receiving endocrine therapy found that effective communication between healthcare professionals and patients is important for medication adherence and reported a role for consistent support, including support provided by nurses (Smits et al., 2025). Although the review focused on breast cancer endocrine therapy, its findings demonstrate the broader relevance of communication strategies to medication-taking behaviour and also indicate why communication should be examined within specific clinical populations rather than assumed to have identical effects across all conditions.

Medication adherence is also influenced by the complexity of treatment and by patients’ individual circumstances. Patients attending outpatient clinics may be receiving medicines for acute illnesses, chronic diseases or follow-up conditions, and some may have to take several medicines at different times of the day. The WHO (2003) identifies treatment-related factors, patient-related factors and healthcare-system factors among the determinants of adherence and notes that interventions designed to improve adherence may include information, counselling, reminders, self-monitoring and reinforcement. This suggests that communication should be considered as part of a broader adherence-support process rather than as an isolated activity. For nurses working in outpatient clinics, effective communication may therefore involve not only giving medication instructions but also identifying patients’ difficulties, checking understanding and providing appropriate reinforcement.

The Nigerian healthcare environment provides an important context for examining communication and medication-related behaviours because patients may experience barriers related to health literacy, healthcare access, treatment costs, waiting times and interactions with healthcare providers. Evidence from Nigeria has also demonstrated that nursing practice can be affected by communication and information-related issues. For example, a study of nurses’ adherence to medication-administration guidelines in a health facility in South-West Nigeria found that 49.3% of observed nurses did not provide information about the medication during administration, while the overall level of non-adherence to medication-administration guidelines was 48%. Although this study examined nurses’ adherence to medication-administration guidelines rather than patients’ medication adherence, it illustrates the importance of information provision within nursing medication-related practice and provides a Nigerian context for examining how communication may influence medication use (Afolabi et al., 2021).

Outpatient clinics in selected hospitals in Enugu State provide a relevant setting for examining nurse communication and medication adherence because patients often receive treatment instructions and medications while managing their health outside the hospital environment. Unlike admitted patients who remain under continuous observation, outpatients are generally responsible for implementing medication instructions within their homes and communities. Effective communication may therefore be particularly important in ensuring that patients understand what medicines they have been prescribed, how they should be taken and what to do when difficulties arise. Existing evidence supports an association between healthcare communication and treatment adherence, but the available literature also shows variation according to healthcare setting, patient population, intervention and method of measuring adherence (Keshtkar et al., 2026; Smits et al., 2025). Therefore, a study specifically examining the effect of nurse communication on medication adherence among patients attending selected outpatient clinics in Enugu State is warranted.

1.2 Statement of the Problem

Medication adherence remains a significant challenge in healthcare because patients may fail to take medicines according to prescribed instructions for various reasons. The WHO (2003) reported that poor adherence to long-term therapies is a widespread problem and emphasised that healthcare providers and health systems can influence patients’ adherence behaviour. Poor adherence may reduce the potential benefits of prescribed medicines and contribute to preventable complications, additional healthcare utilisation and increased healthcare costs. Since medication adherence is influenced by several interacting factors, there is a need to examine modifiable factors within healthcare delivery, including the quality of communication between healthcare professionals and patients.

One important concern is that patients may leave outpatient consultations without fully understanding their medication instructions. Information concerning dosage, timing, duration, possible side effects and what to do when a dose is missed may not always be adequately understood. The problem may become more pronounced where healthcare professionals face high workloads, limited consultation time, language differences or other communication barriers. A 2024 African scoping review identified several barriers affecting therapeutic communication between nurses and patients, demonstrating that effective nurse–patient communication cannot always be assumed within healthcare environments (Abraham et al., 2024). These communication challenges raise questions about whether patients attending outpatient clinics in selected hospitals in Enugu State receive sufficiently clear and patient-centred medication information.

Another concern is the uncertainty surrounding the extent to which nurse communication actually translates into improved medication adherence in specific healthcare settings. Recent systematic evidence suggests that communication and adherence are related, but the strength and certainty of this relationship vary across study designs and patient populations. Keshtkar et al. (2026), for example, identified evidence supporting a positive relationship between healthcare practitioner communication and adherence in observational studies but reported that the evidence from randomised controlled trials was less conclusive. Similarly, evidence from communication interventions has shown potential benefits while also highlighting the need for further research. This means that the relationship should be investigated empirically among patients attending outpatient clinics in Enugu State rather than assuming that effective communication automatically produces medication adherence.

The specific problem addressed by this study is therefore the need for empirical evidence on the effect of nurse communication on medication adherence among patients attending outpatient clinics in selected hospitals in Enugu State. There is a need to determine the quality of communication experienced by patients, assess their level of medication adherence, examine the relationship between nurse communication and adherence, and identify communication-related and patient-related factors that may affect adherence. Without such evidence, it may be difficult for nurses, hospital administrators and other healthcare stakeholders to determine whether existing communication practices adequately support patients’ medication-taking behaviour. The study will therefore provide context-specific evidence that may contribute to improvements in patient education, therapeutic communication and medication-adherence support in outpatient healthcare settings.

1.3 Purpose of the Study

The main purpose of this study is to examine the effect of nurse communication on medication adherence among patients attending outpatient clinics in selected hospitals in Enugu State.

1.4 Objectives of the Study

The specific objectives of the study are to:

1. Assess the level and quality of nurse communication experienced by patients attending outpatient clinics in selected hospitals in Enugu State.
2. Determine the level of medication adherence among patients attending the selected outpatient clinics.
3. Examine the relationship between nurse communication and medication adherence among patients attending the selected outpatient clinics.
4. Identify communication-related and patient-related factors that may influence medication adherence among patients attending the selected outpatient clinics.

1.5 Research Questions

The following research questions will guide the study:

1. What is the level and quality of nurse communication experienced by patients attending outpatient clinics in selected hospitals in Enugu State?
2. What is the level of medication adherence among patients attending the selected outpatient clinics?
3. What relationship exists between nurse communication and medication adherence among patients attending the selected outpatient clinics?
4. What communication-related and patient-related factors influence medication adherence among patients attending the selected outpatient clinics?

1.6 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between nurse communication and medication adherence among patients attending outpatient clinics in selected hospitals in Enugu State.

1.7 Significance of the Study

The findings of this study are expected to be beneficial to patients, nurses, hospital management, healthcare policymakers, nursing educators and researchers.

Patients: The study may help patients understand the importance of effective communication with nurses when receiving medication instructions. It may highlight the value of asking questions, reporting medication-related difficulties and seeking clarification when treatment instructions are unclear. The findings may also draw attention to communication barriers that prevent patients from understanding and following their prescribed medication regimens.

Nurses: The study may provide useful information about how patients perceive nurses’ communication practices and how these practices relate to medication adherence. The findings may encourage nurses to pay greater attention to clear explanations, active listening, empathy, respectful interactions and opportunities for patients to ask questions.

Hospital Management: The findings may assist hospital administrators in identifying areas where communication practices within outpatient clinics require improvement. They may also inform decisions concerning patient education, nursing communication training, consultation procedures and the organisation of outpatient services.

Healthcare Policymakers: The study may provide information that can support policies and strategies aimed at improving patient-centred care and medication adherence. Its findings may help policymakers consider communication as an important component of healthcare quality and patient safety.

Nursing Educators: The findings may contribute to nursing education by highlighting communication skills that are relevant to patient understanding and adherence. They may help educators strengthen the teaching of therapeutic communication, patient counselling and medication education in nursing training programmes.

Researchers and Students: The study may contribute to the literature on nurse–patient communication, medication adherence and outpatient healthcare delivery in Nigeria. It may also provide a reference for students and researchers undertaking further studies on communication practices and treatment outcomes among patients attending healthcare facilities.

1.8 Scope of the Study

The study focuses on the effect of nurse communication on medication adherence among patients attending outpatient clinics in selected hospitals in Enugu State, Nigeria.

Geographical Scope: The research will be conducted in selected hospitals in Enugu State. The specific hospitals will be identified based on their relevance to the study, accessibility and the availability of outpatient services.

Content Scope: The study will examine the quality and nature of nurse communication with outpatient clinic patients, patients’ understanding of medication instructions, the level of medication adherence, the relationship between nurse communication and medication adherence, and communication-related and patient-related factors that may influence adherence.

Population Scope: The study will focus on eligible patients attending outpatient clinics in the selected hospitals. The inclusion criteria, sample size and sampling technique will be specified in the methodology chapter.

1.9 Operational Definition of Terms

Nurse Communication: This refers to the verbal and non-verbal interactions between nurses and patients, particularly when nurses provide medication information, explain treatment instructions, respond to questions and discuss patients’ concerns.

Medication Adherence: This refers to the extent to which a patient’s medication-taking behaviour corresponds with the recommendations agreed upon with a qualified healthcare professional.

Outpatient Clinic: This refers to a hospital department or service where patients receive consultation, examination, treatment or follow-up care without being admitted to the hospital overnight.

Patients: These are individuals receiving healthcare services at the outpatient clinics of the selected hospitals in Enugu State.

Therapeutic Communication: This refers to purposeful communication used by nurses to establish a professional helping relationship, understand patients’ concerns and support their healthcare needs.

Medication Instructions: These refer to directions given to patients concerning how, when and for how long prescribed medicines should be taken, including relevant precautions.

Patient Understanding: This refers to the extent to which patients comprehend information provided by nurses about their medications and treatment plans.

Communication Barriers: These refer to factors that interfere with the effective exchange or understanding of information between nurses and patients, such as unclear explanations, language differences, limited consultation time or inadequate opportunities for questions.

Selected Hospitals: These refer to the healthcare facilities in Enugu State that will be chosen as the study locations.

Project – The Effect of Nurse Communication on Medication Adherence among Patients Attending Outpatient Clinics: A Study of Selected Hospitals in Enugu State