Abstract
A longitudinal study of patients with chronic medical diseases (hypertension, diabetes, heart disease) was conducted to identify antecedents of adherence to medical recommendations. Data are from 1198 patients in three health-care provision systems in Los Angeles, Chicago, and Boston. Nonadherence at the beginning of the study was the strongest predictor of nonadherence 2 years later. Other significant predictors varied by type of adherence outcome. Patients who were younger and who relied upon avoidant coping strategies tended to be less likely to follow their doctor's specific recommendations. Patients who were distressed about their health, used avoidant coping strategies, or who reported worse physical and role functioning were less likely to adhere in general. Patient satisfaction with two features of care (interpersonal quality and financial aspects) was positively related to adherence in some models, but satisfaction with the technical quality of care was negatively associated with adherence to specific recommendations among heart disease patients. Social support contributed to specific adherence among diabetic patients. Implications of the study for medical care providers are discussed.
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Ajzen, I., and Fishbein, M. (1980).Understanding Attitudes and Predicting Social Behavior, Prentice-Hall, Englewood Cliffs, NJ.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change.Psychol. Rev. 84: 191–215.
Becker, M. H. (1985). Patient adherence to prescribed therapies.Med. Care 23: 539–555.
Becker, M. H., and Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations.Med. Care 13: 10–24.
Becker, M. H., and Maiman, L. A. (1980). Strategies for enhancing patient compliance.J. Comm. Health 6: 113–135.
Bentler, P. M., and Speckart, G. (1979). Models of attitude-behavior relations.Psychol. Rev. 86: 452–464.
Bentler, P. M., and Speckart, G. (1981). Attitudes “cause” behaviors: A structural equation analysis.J. Personal. Soc. Psychol. 40: 226–238.
Billings, A. G., and Moos, R. H. (1981). The role of coping responses in attenuating the impact of stressful life events.J. Behav. Med. 4: 139–157.
Burnam, M. A., Wells, K. B., Leake, B., and Landesverk, J. (1988). Development of a brief screening instrument for detecting depressive disorders.Med. Care 26: 775–789.
Cassem, N. H., and Hackett, T. P. (1971). Psychiatric consultation in a coronary care unit.Ann. Intern. Med. 75: 9–14.
Champion, V. L. (1990). Breast self-examination in women 35 and older: A prospective study.J. Behav. Med. 13: 523–538.
Cohen, S. (1979). Rehabilitation of the stroke patient.Md. State Med. J. 28: 82–83.
Croog, S. H., Shapiro, D. S., and Levine, S. (1971). Denial among male heart patients.Psychosom. Med. 33: 385–397.
DiMatteo, M. R., and DiNicola, D. D. (1982).Achieving Patient Compliance: The Psychology of the Medical Practitioner's Role, Pergamon Press, New York.
DiMatteo, M. R., Hays, R. D., and Sherbourne, C. D. (1992). Adherence to cancer regimens: Implications for treating the older patient.Oncology 6(2): 50–57s.
DiNicola, D. D., and DiMatteo, M. R. (1982). Communication, interpersonal influence, and resistance to medical treatment.Basic Processes in Helping Relationships, Academic Press, New York.
Felton, B. J., Revenson, T. A., and Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults.Soc. Sci. Med. 18(10): 889–898.
Folkman, S., and Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample.J. Health Soc. Behav. 21: 219–239.
Haynes, R. B. (1976). A critical review of the “determinants” of patient compliance with therapeutic regimens. In Sackett, D. L., and Haynes, R. B. (eds.),Compliance with Therapeutic Regimens, The Johns Hopkins University Press, Baltimore, pp. 26–39.
Haynes, R. B., Taylor, D. W., and Sackett, D. L. (1979).Compliance in Health Care, Johns Hopkins University Press, Baltimore, MD.
Hays, R. D., and DiMatteo, M. R. (1987). Key issues and suggestions for patient compliance assessment: Source of information, focus of measures, and nature of response options.J. Compliance Health Care 2: 37–53.
Hays, R. D., Davies, A. R., and Ware, J. E. (1987).Scoring the Medical Outcomes Study Patient Satisfaction Questionnaire: PSQ-III, unpublished memorandum.
Hays, R. D., Hayashi, T., and Stewart, A. L. (1989). A five-item measure of socially desirable response set.Educ. Psychol. Measure. 49: 629–636.
Helmstadter, G. C. (1964).Principles of Psychological Measurement, Appleton-Century-Crofts, New York.
Hulka, B. S., Kupper, L. L., Cassel, J. C., and Mayo, F. (1975). Doctor-patient communication and outcomes among diabetic patients.J. Commun. Health 1: 15–27.
Krantz, D. S., and Deckel, A. W. (1983). Coping with coronary heart disease and stroke. In Burish, T. G., and Bradley, L. A., (eds.),Coping with Chronic Disease, Academic Press, New York.
Kravitz, R. L., Hays, R. D., Sherbourne, C. D., DiMatteo, M. R., Rogers, W. H., Ordway, L., and Greenfield, S. (1992). Receipt of recommendations and adherence to advice among patients with chronic medical conditions: Results from the Medical Outcomes Study (submitted for publication).
Kruse, W., and Weber, E. (1990). Dynamics of drug-regimen compliance — Its assessment by microprocessor-based monitoring.Eur. J. Clin. Pharmacol. 38: 561–565.
Lau, R. R., Hartman, K. A., and Ware, J. E. (1986). Health as a value: Methodological and theoretical considerations.Health Psychol. 5: 25–43.
Linn, M. W., Linn, B. S., and Stein, S. R. (1982). Satisfaction with ambulatory care and compliance in older patients.Med. Care 20: 606.
Luscher, T. F., and Vetter, W. (1990). Adherence to medication.J. Hum. Hypertens. 4 (Suppl. 1): 43–46.
Meichenbaum, D. H., and Turk, D. C. (1987).Facilitating Treatment Adherence: A Practitioner's Guidebook, Plenum Press, New York.
Moos, R. H., and Schaefer, J. A. (1984). The crisis of physical illness: An overview and conceptual approach. In Moos, R. H. (ed.),Coping with Physical Illness: New Directions, Plenum, New York.
Myers, R. E., Trock, B. J., Lerman, C., Wolf, T., Ross, E., and Engstrom, P. F. (1990). Adherence to colerectal cancer screening in an HMO population.Prevent. Med. 19: 502–514.
Nagy, V. T., and Wolfe, G. R. (1984). Cognitive predictors of compliance in chronic disease patients.Med. Care 22(10): 912–921.
Page, P., Verstraete, D. G., Robb, J. R., and Etzwiler, D. D. (1981). Patient recall of self-care recommendations in diabetics.Diabetes Care 4: 96–98.
Paskett, E. D., Carter, W. B., Chu, J., and White, E. (1990). Compliance behavior in women with abnormal pap smears.Med. Care 28(7): 643–656.
Rogers, W., McGlynn, E., Berry, W., Nelson, E., Perrin, E., Zubkoff, M., Greenfield, S., Wells, K. B., Stewart, A. L., Arnold, S., and Ware, J. E. (1992). Methods of sampling. In Stewart, A. L., and Ware, J. E., Jr. (eds.),Measuring Functioning and Well-Being: The Medical Outcomes Study Approach, Duke University Press, Durham, NC, pp. 27–47.
Ronis, D. L., and Harel, Y. (1989). Health beliefs and breast examination behaviors: Analyses of linear structural relations.Psychol. Health 3: 259–285.
Rosenstock, I. M. (1988). Enhancing patient compliance with health recommendations.J. Pediat. Health Care 2(2): 67–72.
Sherbourne, C. D., and Hays, R. D. (1990). Marital status, social support, and health transitions in chronic disease patients.J. Health Soc. Behav. 31: 328–343.
Sherbourne, C. D., and Kamberg, C. (1992). Social functioning: Family and marital functioning measures. In Stewart, A. L., and Ware, J. E., Jr. (eds.),Measuring Functioning and Well-Being: The Medical Outcomes Study Approach, Duke University Press, Durham, NC, pp. 182–193.
Sherbourne, C. D., and Stewart, A. L. (1991). The MOS social support survey.Soc. Sci. Med. 32: 705–714.
Steele, D. J., Jackson, T. C., and Gutmann, M. C. (1990). Have you been taking your pills? The adherence-monitoring sequence in the medical interview.J. Family Pract. 30: 294–299.
Steptoe, A., and O'Sullivan, J. (1986). Monitoring and blunting coping styles in women prior to surgery.Br. J. Clin. Psychol. 25: 143–144.
Stewart, A. L., Hays, R. D., and Ware, J. E. (1992a). Health perceptions, energy/fatigue, and health distress measures. In Stewart, A. L., and Ware, J. E. (eds.),Measuring Functioning and Weil-Being: The Medical Outcomes Study Approach, Duke University Press, Durham, NC, pp. 143–172.
Stewart, A. L., Ware, J. E., Sherbourne, C. D., and Wells, K. (1992b). Psychological distress/well-being and cognitive functioning measures. In Stewart, A. L., and Ware, J. E. (eds.),Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Duke University Press, Durham, NC, pp. 102–142.
Sutton, S. R., and Eiser, J. R. (1990). The decision to wear a seat belt: The role of cognitive factors, fear, and prior behaviour.Psycho. Health 4: 111–123.
Tarlov, A. R., Ware, J. E., Greenfield, S., Nelson, E. C., Perrin, E., and Zubkoff, M. (1989). Medical Outcomes Study: An application of methods for evaluating the results of medical care.JAMA 262: 907–913.
Wartman, S. A., Morlock, L. L., Malitz, F. E., and Palm, E. A. (1983). Patient understanding and satisfaction as predictors of compliance.Med. Care 21: 886–891.
Winfield, A. J., Jessiman, D., Williams, A., and Esakowitz, L. (1990). A study of the causes of non-compliance by patients prescribed eyedrops.Br. J. Ophthalmol. 74: 477–480.
Winfree, L. T. (1985). Peers, parents, and adolescent drug use in a rural community: A two-wave panel study.J. Youth Adolesc. 14: 499–512.
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Supported by grants from the Agency for Health Care Policy and Research (Grant HS 06171), the National Institute on Aging, The Robert Wood Johnson Foundation, The Henry J. Kaiser Family Foundation, the National Institute of Mental Health, and the Pew Charitable Trusts, as well as support from RAND. The views expressed are those of the authors and do not necessarily represent those of the sponsors or RAND.
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Sherbourne, C.D., Hays, R.D., Ordway, L. et al. Antecedents of adherence to medical recommendations: Results from the medical outcomes study. J Behav Med 15, 447–468 (1992). https://doi.org/10.1007/BF00844941
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DOI: https://doi.org/10.1007/BF00844941