Health Promotion and Disease Prevention: A Social Action Conception of Compliance Behavior
Craig K. Ewart Johns Hopkins University
Debates about compliance -- what to call it and how to improve it -- often manifest deeper contests between competing notions of health and illness. In this chapter I approach the question of behavioral compliance from a social action or problem-solving perspective in which health, defined as an organism's capacity for self-protective action, is distinguished from wellness, defined as the absence of disease. I maintain that compliance, properly understood, refers to a process through which people develop and enhance their capacity for self-protective activity. Confusion has arisen because compliance can -- and must -- be viewed simultaneously as a desired habit or action state that is the goal of behavioral intervention, a change process through which habits are altered, and a behavioral product of contexts in which habit-change processes operate. A tripartite view of compliance suggests new hypotheses and experiments to advance our understanding of health behavior change in children and generates guidelines for enhancing the long-term impact of health promotion efforts ( Ewart, 1991).
In the first section of this chapter I present a social action conception of compliance behavior and show how it can help clarify the relationship between health promotion and disease prevention, as well as aid in reconciling conflicting views of the patient as an object of health care and its active consumer. I then describe the tripartite model, indicating ways in which action state, process, and contextual dimensions contribute to a more complete understanding of compliance behavior. Finally, by applying the model to the development of compliance capabilities, I outline some promising directions for early preventive intervention.