Schizophrenia represents a chronic and debilitating mental disorder that significantly affects patients’ daily functioning and creates societal challenges. Long-acting injectable antipsychotics (LAIs) have been shown to enhance adherence and lower relapse and hospitalization rates compared with oral antipsychotic treatments, yet their adoption differs widely between countries. The qualitative portion of the global ADVANCE study (Attitudes DriVing regional differences in long-acting injectable ANtipsychotic utilization for schizophrenia among healthcare professionals, patients, and CaregivErs) sought to explore how patients experience the journey from diagnosis to treatment, their goals, and their perspectives on LAIs, as well as how these factors may influence acceptance and use. The study included psychiatrists, psychiatric nurses, adults living with schizophrenia, and caregivers from eight countries: Australia, Canada, China, Germany, Israel, Spain, South Korea, and the United States. Eligible HCPs devoted the majority of their workweek (≥65%) to direct patient care, managed adult populations in which at least 10% were diagnosed with schizophrenia, and had prescribed second-generation LAIs within the past year. Patients were adults (≥18 years) with schizophrenia, and caregivers were included if they had experience with LAI treatment for the patient in their care. Data were collected via 60-minute semi-structured telephone interviews. Interviews were completed by 17 HCPs, 20 patients, and 19 caregivers. HCPs described a recurring cycle in which patients often experienced relapse following treatment, with inpatient services focused on immediate symptom management and outpatient care emphasizing sustained quality of life. Major barriers to LAI adoption reported by HCPs included injection reluctance, logistical hurdles, and previous traumatic experiences related to compulsory injections. Patients’ experiences highlighted two primary care trajectories: (1) early-stage intervention with strong outpatient support, and (2) severe acute episodes necessitating hospitalization. Those whose initial care was outpatient were generally more receptive to LAIs, whereas individuals who first experienced inpatient treatment frequently reported fear, feelings of disempowerment, and hesitancy toward LAIs for long-term management. Caregivers were primarily concerned with maintaining patients’ quality of life and were actively involved in disease management. The nature of interactions between patients and psychiatric professionals varies depending on whether care is delivered in inpatient or outpatient settings, influencing LAI acceptance. Factors such as initial symptom presentation, family involvement, hospitalization history, trust in HCPs, and logistical constraints all appear to shape patients’ attitudes toward LAIs and overall outcomes.
