(2003; 211 pages)
Objectives and target audience
This report is part of the work of the Adherence to Long-term Therapies Project, a global initiative launched in 2001 by the Noncommunicable Diseases and Mental Health Cluster of the World Health Organization.
The main target audience for this report are policy-makers and health managers who can have an impact on national and local policies in ways that will benefit patients, health systems and societies with better health outcomes and economic efficiency. This report will also be a useful reference for scientists and clinicians in their daily work.
The main objective of the project is to improve worldwide rates of adherence to therapies commonly used in treating chronic conditions.
The four objectives of this report are to:
• summarize the existing knowledge on adherence, which will then serve as the basis for further policy development;
• increase awareness among policy-makers and health managers about the problem of poor rates of adherence that exists worldwide, and its health and economic consequences;
• promote discussion of issues related to adherence; and
• provide the basis for policy guidance on adherence for use by individual
• articulating consistent, ethical and evidence-based policy and advocacypositions; and
• managing information by assessing trends and comparing performance, setting the agenda for, and stimulating, research and involvement.
How to read this report
As this report intends to reach a wide group of professionals, with varied disciplines and roles, the inclusion of various topics at different levels of complexity was unavoidable. Also, during the compilation of the report, contributions were received from eminent scientists in different fields, who used their own technical languages, classifications and definitions when discussing adherence.
For the sake of simplicity, a table has been included for each disease reviewed in section III, showing the factors and interventions cited in the text, classified according to the five dimensions proposed by the project group and explained later in this report:
- social- and economic-related factors/interventions;
- health system/health care team-related factors/interventions;
- therapy-related factors/interventions;
- condition-related factors/interventions; and
- patient-related factors/interventions.
The section entitled "Take-home messages" summarizes the main findings of this report and indicates how readers could make use of them.
Setting the scene, discusses the main concepts leading to the definition of adherence and its relevance to epidemiology and economics.
Improving adherence rates: guidance for countries, summarizes the lessons learned from the reviews studied for this report and puts into context the real impact of adherence on health and economics for those who can make a change.
Disease-specific reviews, discusses nine chronic conditions that were reviewed in depth. Readers with clinical practice or disease-oriented programmes will find it useful to read the review related to their current work. Policy-makers and health managers may prefer to move on to the Annexes.
Behavioural mechanisms explaining adherence, provides an interesting summary of the existing models for explaining people's behaviour (adherence or nonadherence), and explores the behavioural interventions that have been tested for improving adherence rates.
Statements by stakeholders, looks at the role of the stakeholder in improving adherence as evaluated by the stakeholders themselves.
Annexes III and IV:
Table of reported factors by condition and dimension and Table of reported interventions by condition and dimension, provide a summary of all the factors and interventions discussed in this report. These tables may be used to look for commonalities among different conditions.
Global Adherence Interdisciplinary network (GAIN), lists the members of this network.