This week’s focus is on presenting an overview of the factors that commonly affect adherence to treatment.  The examples given are not an exhaustive list, but rather an introduction to the topic.

The World Health Organization identifies five interacting dimensions of adherence1: 1) Patient-related factors, 2) Social/economic factors, 3) Condition-related factors, 4) Therapy-related factors, and 5) Health system/healthcare team.

Previously, in the blog titled Why One Size Does Not Fit All we were mainly focused on patient-related factors in persons with type 2 diabetes, although we also touched slightly on other factors.  Some of the patient-related factors previously discussed were: knowledge about the disease, motivation, confidence in the ability to follow treatment (also called self-efficacy), depression, and stress.  Other examples of patient-related factors include: the perceived risk and/or benefit of therapy, expectations and attitudes about the disease or treatment, and fear of possible negative effects.  Social/economic factors such as health literacy, social support and medication/treatment costs are also important contributors to adherence.

The next set of factors depends on the condition or disease itself and its treatment.  Examples of important condition-related factors are chronicity (that is, whether the health issue is acute or chronic) and the severity of symptoms.  Some health problems have only mild symptoms (or none at all) and this can make adherence quite challenging since it may not be obvious whether you are getter better or sicker.  Therapy-related factors include how complex the therapy is, how long the therapy or treatment lasts, how much it interferes with a person’s lifestyle, and how much effort is required to stick with the therapy and/or change established behaviors.

The health system/healthcare team also plays a big role in adherence.  The health system is different across countries so there can be wide variation, depending on where you live, in things that affect adherence – such as the availability or accessibility of different kinds of medications or treatments, medication costs, and wait times.  The healthcare team is also a very important part of adherence and this doesn’t only include doctors but also pharmacists (and others – e.g., nurses).  The healthcare team can affect adherence by:  how much time is spent discussing health issues and treatment options, the kind and complexity of language used, how much or how often positive reinforcement is given, and how aligned the ‘provider’ and patient are in terms of their health-related values and beliefs.

The American College of Preventive Medicine recently published a document titled ‘Medication Adherence – Improving Health Outcomes’ (2011) summarizing the evidence on factors that affect adherence and strategies to improve adherence, specifically for a clinical audience.  If you are a clinician (doctor, nurse, pharmacist), this is a great resource for more information about the role of the health system/healthcare team in adherence. Click Here to find out more.

References:

1. Sabate E. Adherence to long-term therapies. Evidence for action. 2003. Geneva, Switzerland: World Health Organization\

http://www.who.int/chp/knowledge/publications/adherence_report/en/index.html. Accessed 1/12/2011.

2. American Society of Consultant Pharmacists. Adult Meducation. Improving medication adherence in older adults.

http://www.adultmeducation.com/downloads/Adult_Meducation.pdf. Accessed 1/12/2011.