Exploring Factors Contributing to Treatment Relapse Among Schizophrenia Clients at Zomba Mental Hospital, Malawi: A Phenomenological Study Guided by Andersen's Behavioural Model of Health Services Use

Abstract Background Schizophrenia is a chronic mental disorder with global relapse rates ranging from 44% to 69%. In Malawi, treatment relapse contributes to repeated hospitalisation, rising healthcare costs, and poor quality of life, yet the factors driving relapse at Zomba Mental Hospital have not been well characterised using an explicit health-services framework. Methods A phenomenological research design was used, guided by Andersen's Behavioural Model of Health Services Use. In-depth interviews were conducted with 10 purposively sampled clients with a history of treatment relapse admitted to the rehabilitation wards. Data were analysed using Braun and Clarke's six-step reflective thematic analysis. Trustworthiness was established through credibility, dependability, transferability, and confirmability. Results Findings clustered around three of Andersen's core constructs. Predisposing factors included poor illness insight, cultural attributions such as witchcraft, and low health literacy. Enabling factors included long travel distances, antipsychotic stock-outs, unemployment, stigma, and weak post-discharge follow-up. Need factors included perceived wellness that prompted self-discontinuation of medication and unresolved emotional distress. These, in turn, shaped health behaviours, irregular adherence and alcohol or cannabis use, that culminated in relapse. Conclusion Treatment relapse among schizophrenia clients at Zomba Mental Hospital is best understood as the product of interacting predisposing, enabling, and need factors rather than any single cause. Interventions structured around these three levels, psychoeducation, health-system strengthening, and psychosocial support, are recommended to reduce relapse in this setting.