Causes of Non-Adherence

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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.

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