A Patient-Centered Approach
to Adherence: Risks for Nonadherence
Laurie J. Bauman Albert Einstein College of Medicine, Bronx, NY
The two dominant theoretical approaches used in adherence research-- Adherence/Compliance and the Health Belief Model--have provided a rich and important foundation for understanding patient behavior. However, despite the huge investment in compliance research and over 10,000 articles published, patient noncompliance remains high, with more than half of patients failing to take medications properly ( Donovan, 1995). A new approach needs to incorporate the strengths of existing frameworks but enhance our ability to guide interventions. This new approach begins with three observations: (a) Noncompliance is common, therefore models that treat nonadherence as unexpected or deviant are of limited utility. (b) There are different kinds of nonadherence that have different risk factors, pose different clinical problems, and require different interventions. (c) The assumption by providers that patients should and will comply with provider advice leads to defining the problem of nonadherence in a limited, static way: "Why don't patients comply?" This chapter presents a different way of looking at adherence--by conceptualizing it from the patient view rather than the provider view.
From the provider perspective, it is puzzling and frustrating to have successful medical treatments available for a patient's serious health condition only to have them ignored. In the provider's mind, the patient came for care and sought his or her advice, and therefore should comply with the prescribed medical regimen. From patients' points of view, providers are an important source of needed information about their health and