Promoting Adherence to Medical Treatment in Chronic Childhood Illness: Concepts, Methods, and Interventions

By Dennis Drotar | Go to book overview

PART III
CONCEPTUAL MODELS OF ADHERENCE AND COMPLIANCE FOR CLINICAL CARE AND RESEARCH

In this section, authors contribute new conceptual models that promise to enhance understanding of adherence. In chap. 4, Bauman presents a patient-centered model of treatment adherence that broadens our understanding of the factors that influence treatment adherence and the factors that may affect treatment compliance. Arguing convincingly that treatment nonadherence is a common problem and in many ways more the exception than the rule, she critically evaluates the assumptions of conceptual models that have been utilized to understand patient behavior in response to medical advice. Bauman questions the major assumptions that underlie the traditional adherence/compliance model (e.g., that patients with health problems should comply with treatment to reduce symptoms and should be motivated to initiate and maintain treatment). Bauman contrasts these assumptions with those that underlie the Health Belief Model, which does not assume that treatment adherence is expected and focuses on patients' perceptions of beliefs to treatment.

Bauman also describes the need to consider and understand different types of adherence, such as volitional adherence (in which the patient has heard and understood a provider's advice but makes an informed choice not to comply with treatment) versus inadvertent nonadherence (in which patients accept their providers' advice and attempt to implement the treatment, but for a variety of reasons do not do what was prescribed). She considers the multitude of risk factors that can affect treatment compliance, including patient-related factors (e.g., concerns about side effects,

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