Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Open this folder and view contentsSection I - Setting the scene
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
Open this folder and view contentsChapter IX - Depression
Open this folder and view contentsChapter X - Diabetes
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Open this folder and view contentsChapter XIII - Hypertension
Open this folder and view contentsChapter XIV - Tobacco smoking cessation
Close this folderChapter XV - Tuberculosis
View the document1. Definition of adherence
View the document2. Factors that influence adherence to treatment
View the document3. Prediction of adherence
View the document4. Strategies to improve adherence to treatment
View the document5. Questions for future research
View the document6. References
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book

3. Prediction of adherence

If the individuals at risk for poor adherence could be identified early in their management, health care providers should, in theory, be able to intervene by tailoring the provision of treatment to enable such patients to continue their therapy. Unfortunately, the available evidence indicates that health care providers are unable to predict accurately which patients are likely to be nonadherent (21 - 23).

The literature describes over 200 variables associated with patients who default on treatment. Many of the cited determinants of adherence are unalterable, and the demonstration of a consistent association between characteristics such as gender, age group or literacy and adherence does not lead to a logical approaching to remedy the situation. Furthermore, demographic, social and other patient characteristics often relate poorly to the patient's intention or motivation and do not explain why some TB patients adhere to treatment despite having several unfavourable characteristics. Patients with TB apparently fluctuate in the intensity of their motivation to complete their treatment and admit to considering defaulting many times during their long course of therapy (24).

Many epidemiological studies have explored correlates of adherence, often examining the issue from a biomedical perspective. Within this framework the TB patient has sometimes been seen as a recipient of a treatment regimen, who should obey the instructions of the health care worker. Nonadherent patients who do not conform to these expectations have sometimes been regarded as "deviant". This approach ignores the fact that treatment behaviour is complex and is influenced by a host of factors including the patients' sociocultural setting, health beliefs and subjective experience of the illness.

Numerous psychosocial constructs have been proposed that have attempted to provide a conceptual model for thinking about health behaviour (24 - 28). The information - motivation - behavioural (IMB) skills model (29) which integrates information, motivation and behavioural skills in explaining behaviour has, however, attracted some attention as a potentially useful guide to developing interventions for enhancing adherence to TB treatment. The IMB model demonstrates that information is a prerequisite for good adherence, but is not sufficient in itself to change behaviour. Motivation and the development of behavioural skills are also critical determinants of behavioural change.

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