Communication in Pediatric Adherence:
Implications for Research
and Clinical Practice
M. Robin DiMatteo University of California, Riverside, CA
Failure to adhere to medical treatment regimens is a complex and often frustrating phenomenon that appears to be influenced by a vast array of social and psychological factors. In the case of adult chronic illness, the influences of the physician-patient relationship and patients' beliefs, feelings, habits, social norms, and social support on patients' choices to follow or avoid medical advice are well established. When the adherence of a child or adolescent to chronic illness treatment is at stake, there is the potential for even greater complexity in determining adherence if only because more people each with their unique perspectives, opinions, developmental stages, and relationships, are involved.
The conceptual work and empirical research on the role of communication in adherence is relatively well established in research on adults with chronic illness. Issues of communication have received less attention, however, in the study of interactions in the pediatric realm ( Glasgow & Anderson , 1995). Consequently, there is much to be learned about relationships among patients, pediatricians, and families, as well as about issues of active patient involvement, trust, and negotiation--particularly about how these factors foster or inhibit adherence to prescribed treatments.
To address this need, the goals of this chapter are several. The first is to delineate the relationship between adherence and communication among providers, pediatric patients, and their families and to review this relatively new area of empirical research for pediatric populations. Another goal is to suggest some possible clinical applications of what is currently known,