(2003; 211 pages)
1. Patients need to be supported, not blamed
Despite evidence to the contrary, there continues to be a tendency to focus on patient-related factors as the causes of problems with adherence, to the relative neglect of provider and health system-related determinants. These latter factors make up the health care environment in which patients receive care and have a considerable effect on adherence. Interventions that target the relevant factors in the health care environment are urgently required.
Patients may also become frustrated if their preferences in treatment-related decisions are not elicited and taken into account. For example, patients who felt less empowered in relation to treatment decisions had more negative attitudes towards prescribed antiretroviral therapy and reported lower rates of adherence (1).
Adherence is related to the way in which individuals judge personal need for a medication relative to their concerns about its potential adverse effects (2). Horne et al. proposed a simple necessity-concerns framework to help clinicians elicit and address some of the key beliefs that influence patients' adherence to medication. Necessity beliefs and concerns are evaluative summations of the personal salience of the potential costs and benefits or pros and cons of the treatment (3).