Patient Compliance/Adherence

An analysis of the treatment given to chronically ill patients and how they respond and manage to adhere to it.

This paper critically analyses the factors that may contribute to the chronically ill person maintaining or not maintaing adherence to treatment. Five related areas of concern associated with compliance metatheory are briefly reviewed. It is asserted that theory building, assessment, research, and clinical application have been needlessly constrained as a result of the tendency of compliance investigations to be: (a) unidimensional, (b) practitioner centered, (c) reductionist, (d) stability (consistency) oriented, and (e) a motivational. The problem listing is then followed by a discussion of potential conceptual alternatives, and by the presentation of a tentative family of terms to replace the current overextended usage of the compliance label.
“Compliance is usually defined as a technical problem that is a theoretical in nature; that is to say, compliance is a problem associated with getting the patient to behave in accord with medical advice. Karoly finds this definition to be somewhat sterile and urges that compliance should be thought of as a construct not unlike intelligence. Karoly argues that control theory offers a useful meta-analytic framework for conceptualizing the construct. The power of this approach is that it offers the possibility of combining cause-effect models and those that attempt to analyze “properties of people and/or systems (e.g., families) that are capable of yielding consistencies in health maintaining behavior.” Karoly offers a triarchic model of compliance that is analogous to Sternberg’s model of the construct of intelligence.”