Determinants of adherence
A considerable amount of empirical, descriptive, research has identified correlates and predictors of
adherence and nonadherence.These include aspects of the complexity and duration of treatment, characteristics
of the illness, iatrogenic effects of treatment, costs of treatment, characteristics of health service
provision, interaction between practitioner and patient, and sociodemographic variables.Many of
these variables are static, and may not be amenable to intervention.They have been well described in
the main text of this report and will not be discussed further here.While such findings help to identify
risk factors, they tend to be discrete and atheoretical, and not very helpful in guiding a clinical approach
to this problem.
This section describes several important variables that are behavioural in nature and are also dynamic,
and therefore amenable to intervention. First we identify key behaviours of health care providers, health
system factors and attributes of patients.Then we discuss promising behavioural science theories and
models that help to explain behavioural change.These serve as helpful heuristics both for understanding
nonadherence and for addressing it.