The Link Between Medication Adherence and Academic Performance

Medication Adherence Defined

Medication adherence means how far a patient’s behaviour aligns with instructions from their healthcare professional or how accurately they are following their healthcare plan.

Medication adherence encompasses:

• Taking medicine as prescribed (including the correct dose at the correct times)
• Storing medicine as instructed
• Appropriate access to medicine

Following guidelines and taking medication as prescribed is vital to keep symptoms under control and maintain overall health. 

There are different types of non-adherence:

1. Primary non-adherence – this is where the prescription is written out by a doctor, nurse or other clinician but the patient never takes it to a pharmacy to collect.
2. Non-persistence – this is when a patient decides to stop taking their medication, despite not being advised to do so by a medical professional.
3. Non-conforming – this can take many forms, but generally means that the patient isn’t following the instructions given. This might be by skipping doses, taking more or less than prescribed, keeping medicine at the wrong temperature etc.

Research conducted into medication non-adherence has found that there are various reasons that a patient collects a prescription then decides not to follow through and get their medicine or decides to stop taking it altogether or takes it incorrectly. 

Medication non-adherence may be done intentionally or non-intentionally. 

Not taking our medicine has a range of impacts on our health and day-to-day life. For students, not following the instructions of their clinician or failing to take medication can have a significant impact on their studies, leading to absences, problems at school and lower grades.

Medication in Educational Settings

Students may require routine medication on a daily, or periodic, basis for conditions such as:

• Asthma
• Allergies
• ADHD
• Diabetes
• Hay fever

Common medicines that students need to take may include inhalers, antihistamines, insulin or painkillers. They may also require emergency medication such as adrenaline auto-injectors (such as EpiPens) needed to treat severe allergic reactions (anaphylaxis). 

Some students may have to take antibiotics when they are fighting an infection or are post-surgery. Antibiotics have to be evenly spaced throughout the day, so it is likely that a student may require a dose whilst at school or college. Courses of antibiotics need to be completed, even if you start to feel better before you have finished the course. This means that if you are prescribed a 7-day course and start to feel better on day 5, you should continue to take them until all the medicine is gone. Failing to do so can lead to the infection recurring and the patient developing potential immunity to the antibiotic, meaning it will not work effectively in future. 

There will also be pupils in some educational settings that have serious conditions that require medication to be administered at school such as medicine for heart conditions or other long-term illnesses. These students will often have an individual healthcare plan (IHCP) in place.

Academic Impact

Medication adherence is linked to academic performance. Students who take their medication as prescribed are less likely to experience relapses and their symptoms are more likely to be kept under control.

If you need medicine to manage any kind of health condition, it stands to reason that if you take it as prescribed and it is working, you will feel better and thus perform better at school. You are not going to perform at your best in lessons or exams if you feel unwell. 

Medication adherence supports overall health and wellbeing. If you miss doses, this may prevent medication from working as well, and in some cases it can cause the body to withdraw which can present unpleasant side effects. Taking too much or too little will cause your medicine not to work as it should and, in some cases, taking too much could also lead to an overdose.

Children who find medicine works to control their ADHD symptoms may struggle to concentrate or perform at their best if they forget to take it. This can impair academic performance and lead to disruption in class. 

If you need medicine for a serious condition, failing to adhere to your medication regimen could risk you needing time off school for medical treatment or even a stay in the hospital. Just a few days of absence each year can have an impact on academic performance. Research has found a link between attendance and attainment for KS2 and KS4 pupils. It showed that:

• Students with the highest attendance achieved the best GCSE and A-level grades.
• Amongst pupils who missed no sessions over KS2, 83.9% achieved the expected standard.
• Only 40.2% of pupils who were persistently absent achieved the expected standard.

Not taking medication that you need may also lead to an impaired immune system, meaning that you are more susceptible to contracting viruses and other common illnesses that regularly get passed around in schools such as colds, flu or chickenpox. A weak immune system can make it hard to fight off illnesses, resulting in longer absences and more noticeable symptoms.  

There may be another potential non-medical reason for the correlation between medication adherence and academic performance to consider. Students who follow instructions and take their medication as prescribed may be more likely to:

• Trust authority figures
• Be compliant
• Follow rules
• Be less combative
• Have a good memory

These attributes may also lead to better behaviour and effort at school and better academic results than their peers who lack these characteristics. 

Although we know that taking medication as prescribed can improve health and lessen symptoms of illness or disease, it is important to acknowledge that the relationship between medication adherence and academic performance is complex and can be influenced by medical and non-medical factors.

Barriers to Medication Adherence

Some studies have suggested that a person’s education level corresponds to their medication adherence. It may be that some patients lack understanding about how important it is to take medicine as prescribed. 

Other reasons people may have for medication non-adherence may include:

• Barriers to access (such as living in a rural or secluded area, lack of nearby pharmacies)
• Cost (although children under 18 and some benefit claimants are entitled to free prescriptions)
• Unpleasant side effects (some medication can have painful, uncomfortable or embarrassing side effects that make patients decide to stop taking their medicine)
• Lack of understanding
• Forgetfulness
• Poor prior experiences with medicine or healthcare workers
• Denial of the diagnosis
• Taking too much on purpose for a recreational ‘buzz’

Peer pressure and the desire to fit in is often an issue in education, especially amongst teens. One Scottish study of 23 adolescent pupils found that barriers to medication adherence in school included:

• Concerns around ‘image’
• Bullying
• Stigma

One example provided by participants included diabetic children who required insulin injections being labelled as ‘problem drug users’ by peers.

Although the sample was relatively small, these findings support further research into the topic. The results demonstrate the importance of addressing stigma and implementing strategies that will improve medication adherence in young people which can in turn improve their academic performance.

Strategies for Improving Adherence

General strategies to improve medication adherence:

Raising awareness about the consequences of medication non-adherence which include:

• Wasting medicine
• Health consequences (disease progression, relapse etc.)
• Lowered quality of life

Education-specific strategies to improve medication adherence:

Schools can help to tackle issues within their institutions that make students more likely to fail to adhere to their medical plans by:

• Providing a safe and supportive environment
• Having a zero-tolerance approach to bullying
• Providing a clean and private space where students can take their medicine
• Making sure they have competent, trained staff who are responsible for administering medication

Advice for parents and carers

Although some students will take their medicine at school, often parents and carers will have the primary responsibility for their children’s medication adherence. Young people who get the right support at home with their healthcare needs will build up good habits for life. To support your child in developing healthy and compliant attitudes to taking their medication parents should try to:

• Be organised – make sure you have spare inhalers and EpiPens and that prescribed medicine is in date. Don’t wait until the last minute to get prescriptions filled.
• Use technology – set alarms or reminders on your phone to help your child remember to take their medicine.
• Model good behaviour – children learn from what they see at home.
• Be available – make sure to accompany your child to medical appointments and be there for them if they need to talk to you about any concerns.
• Share information – sharing information with your child’s school or college is vital. You should keep them updated about any changes to your child’s health condition or prescription. Make sure you have signed any necessary consent forms.
• Ask questions – young people, especially teens, are often reluctant to open up if something is worrying them. Ask if they have any barriers to taking their medication and if there is anything you can do to make life easier.
• Collaborate with healthcare professionals – if your child is struggling with their meds or having unpleasant side effects, speak to your doctor. Rather than simply stopping taking it, your doctor may be able to provide an alternative or adjust the dosage.

Maintaining overall health is also key to good academic performance. As far as possible, try to ensure that your child has:

• A healthy balanced diet
• Regular exercise
• A good sleep routine
• A safe and supportive home environment
• Good mental health and strong coping strategies for stress

Collaboration with Healthcare Professionals

To ensure medication adherence, a collaborative approach between patients, their families, academic institutions and healthcare professionals is vital.

Schools are places where children of different ages come together to learn and are therefore ideal environments to share information about health and wellbeing with young people. 

Effective collaboration between different agencies can help to:

• Improve health outcomes
• Provide accurate information
• Dispel myths
• Promote empathy and understanding
• Provide continuity of care

Poor communication between healthcare providers and patients is one of the leading causes of medication non-adherence. Sometimes patients may misunderstand the directions they are given; additionally, youngsters may be reliant on their adult caregivers. Parents and carers may be facing significant stress when their children are unwell, meaning they are not best placed to interpret complex medication regimens. Parents may also face educational or language barriers. A collaborative approach offers additional layers of support and gives more opportunity for medication adherence.

Legal and Ethical Considerations

Healthcare professionals and educators need to work together to improve medication adherence in schools, ensuring that staff are well trained, and medicine is stored appropriately and is easily accessible. Providing a safe and private area for students to take their medication may help to deal with issues around stigma and image. 

It is also important to open up conversations at school about how important taking medicine is for some students. Schools should instil a culture that prohibits judgement or stigma around the subject.

Key legislation covers the administration of medication in school, such as:

• Children and Families Act (2014)
• Health and Safety at Work etc. Act (1974)
• Misuse of Drugs Act (1971)
• School Premises Regulations (2012)
• Education Act (1996)

Under Section 100 of the Children and Families Act, schools have a duty to make reasonable arrangements to support all children at school who have medical conditions.

It is also important to understand the role of informed consent in medication administration. School staff should only be able to administer medication when a consent form has been completed and signed by the parent/carer of the child who needs the medication. They will be able to outline their commitment to informed consent and the steps they take to support medication adherence in their Medication Policy. 

Further legal and ethical considerations should be kept in mind around:

• Health and safety
• Record-keeping
• Privacy and confidentiality
• Information sharing
• Proper medicine storage

Good record-keeping can help to support medication adherence as it can flag up students who have failed to take their required dose, are late for their medication or require their supply to be topped up. It can also support clear communication channels with parents and support a collaborative approach. 

We know that we perform at our best and put in the most effort when we feel in good health and high spirits. If students require medication to manage symptoms of illness or to deal with a long-term condition, a holistic approach is necessary to ensure medication adherence. This will involve good communication between healthcare workers, academic institutions and families who should all have the best interests of the student in mind.