Causes of non-adherence

Reasons for patient non-adherence are complex. Researchers have found that the relationship between information given to the patient and the extent to which instructions are followed is not always strong. Information alone does not seem to affect the degree to which patients follow recommendations given by health professionals. Situational, personality, or socioeconomic factors often play a more important role in the extent to which patient follow recommendations than do the knowledge and understanding about what they are to do.

Both internal and external factors seem to influence whether a patient follows health care advice. Internal factors include patient characteristics such as age, culture, social background, values, attitudes, and emotions caused by the disease. External factors include the relationship between the patient and the physician or the nurse; support from family, health care personnel, and friends; and the impact of health education. Studies have shown than men adhere less frequently than women. In addition, unemployed people or those who smoke or drink alcohol are also less adherent. Internal and external factors have a powerful influence on patient decision making and behavior change.

Some studies have found that several features of the therapeutic regimen itself have been correlated with adherence. For example, the more the patient must change his or her lifestyle, the less likely the patient is to follow recommendations. In addition, the less complicated the treatment regimen, the higher the rate of adherence. These findings are consistent with the Health Belief Model. The Health Belief Model proposes that patients act on treatment recommendations when they believe that the benefits of treatment outweigh treatment barriers. They also believe that potential complications are severe and believe that they are at risk of developing complications.

It is clear that the patient must have the knowledge he or she needs for health care management and must accept the recommendations of health care professionals as something they can accept and successfully achieve. Patients cannot carry out recommendations they do not understand and will not carry out recommendations they do not accept. Nurses and other health care professionals must do more than merely give the patient information. They must also be able to identify potential barriers to patient learning and the ability to follow treatment recommendations. They must act as learning facilitators and problem solvers, helping the patient to clarify issues and reach a decision or develop a plan that is compatible with his or her own priorities and lifestyle. Ultimately, patients control what they do with the recommendations they are given. The health care professional’s responsibility is to enable patients to act on their own behalf by providing information, helping with the practical problems of carrying out recommendations, helping them be aware of alternatives, and supporting them in integrating new knowledge.

The patient as a passive recipient of care