Primary author: Stephen Fielding

Adherence


Adherence describes how well an individual’s behavior corresponds to the recommended behaviors of a healthcare provider. Because poor adherence is linked to poorer outcomes, interventions which may increase patient compliance are an important area of research. However, studies to date have shown mixed results. We do know, though, that interventions which utilize both patient education and behavioral approaches are most successful (Dean, Walters, & Hall, 2010).

Compliance is a concept which is closely related to compliance. Compliance describes the intent of the individual to follow recommendations, while adherence describes whether or not the action actually takes place (Buchmann, 1997; Courneya & McAuley, 1995). The study of adherence is complex, and involves many interactions between the patient, environment, and community (Mihalko, et al., 2004). Adherence may be enhanced by actions which increase the perceived self-efficacy of the patient. There are nine tools health care practitioners can use to increase self-efficacy: giving acceptance statements, talking and acting in a benevolent fashion, encouraging self-disclosure to gain insight, using selective positive feedback, building a sense of personal responsibility, attributing endorsed norms to a respected secondary group, eliciting commitment to taking the actions necessary to complete specific recommendations, maintaining an attitude of positive regard, and planning for termination of care from the onset (Buchmann, 1997).
Medication adherence among patients with chronic conditions is especially important (Buchmann, 1997; Dean, et al., 2010;). Adherence experts agree that interventions aimed at increasing medication adherence are most promising when they are simple, and when they are multidisciplinary in nature, including medical, pharmaceutical, social, and technical sciences (Van Dulmen, S., et al., 2008).

Adherence to exercise regimens has also been well-studied, especially in relation to the Theory of Planned Behavior, with the most important constructs in the Theory being attitude and perceived behavioral control. In addition, perceived behavioral control is modified greatly by perceived social support, so interventions aimed at increasing social support will be most successful in influencing perceived behavioral control, and, in turn, adherence (Courneya & McAuley, 1995).

Existing research focuses on adults, and most advice concerning children is simply translated from studies involving adults. However, children do carry a unique set of considerations. Interventions which are effective in promoting adherence in children must also take into consideration the degree of family involvement in routines, and the varying developmental capacities of children and adolescents (Dean, et al., 2010).

By its very nature, adherence is difficult to study. Low-adherence patients are difficult to find and enroll in investigational studies; the baseline adherence level is usually high, leaving little room for improvement in the study. Future research should be designed to specifically study low-adherence individuals (Criswell, et al., 2010; Dean, et al., 2010).
References
Criswell, J.C., Weber, C.A., Yinghui X., & Carter, B.L. (2010). Effect of Self-Efficacy and Social Support on Adherence to Antihypertensive Drugs. Pharmacotherapy, 30(5), 432-441.
Dean, A.J., Walters, J., & Hall, A. (2010). A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness. Archives of Disease in Childhood, 95, 717-723. Doi:10.1136/adc.2009.175125
Buchmann, W.F. (1997) Adherence: a matter of self-efficacy and power. Journal of Advanced Nursing, 26, 132-137.
Courneya, K.S., & McAuley, E. (1995). Cognitive Mediators of the Social Influence-Exercise Adherence Relationship: A Test of the Theory of Planned Behavior. Journal of Behavioral Medicine, 18(5), 499-515.
Mihalko, S.L., Brenes, G.A., Farmer, D.F., Katula, J.A., Balkrishnan, R., & Bowen, D.J. (2004). Challenges and innovations in enhancing adherence. Controlled Clinical Trials, 25, 447-457.
Van Dulmen, S., Sluijs, E., Van Dijk, L., De Ridder, D., Heerdink, R., Bensing, J., & The International Expert Forum on Patient Adherence. Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion. BMC Health Services Research, 8(47). doi:10.1186/1472-6963-8-47