Noncompliance and Non Adherence Behaviors of Patient What is Noncompliance and Nonadherence Behavior?
Noncompliance refers to a patient’s resistance or refusal to follow a prescribed medical regimen or treatment plan. This term often carries a negative connotation, implying that the patient’s failure to comply is a result of disobedience or defiance. Noncompliance can sometimes be seen as a subjective judgment, often used to describe patients who are viewed as uncooperative or unwilling to follow medical advice. It suggests that the patient is at fault for not conforming to treatment guidelines, leading to blame when health outcomes are not achieved (Yach, 2003; Ofri, 2012).
On the other hand, nonadherence is a broader term that refers to a patient’s failure to follow treatment recommendations that have been mutually agreed upon by the patient and healthcare provider. Nonadherence can be either intentional or unintentional and may stem from a variety of factors such as forgetfulness, misunderstanding, or personal beliefs (Resnik, 2005). It is less judgmental than noncompliance and considers the complexities of the patient’s life that may affect their ability to adhere to treatment.
Noncompliance and Nonadherence Behavior in Healthcare
Despite numerous studies on noncompliance, the reasons why patients fail to follow medical regimens remain complex and multifaceted. Noncompliance can be influenced by several factors, including:
- Patient-related factors: Lack of knowledge, motivation, health literacy, stress, forgetfulness, or substance abuse (DiMatteo, 2004).
- Treatment factors: Side effects of medications, complexity of the treatment regimen.
- Disease-related factors: Severity or prognosis of the condition.
- Lifestyle factors: Issues such as transportation, work schedules, and financial constraints.
- Socio-demographic and psychosocial factors: Economic status, depression, anxiety, and social support systems (Chesanow, 2014; Quan, 2016).
Noncompliance is not always harmful. In some cases, a patient’s temporary withdrawal from treatment, known as a time-out, may serve as a coping mechanism during stressful learning situations. After the break, patients may return to their regimen with renewed energy. This suggests that noncompliance is not necessarily a barrier to learning but may sometimes be beneficial (Rosner, 2006).
Nonadherence, as defined by the World Health Organization, is influenced by five major dimensions: socioeconomic factors, patient-related factors, condition-related factors, therapy-related factors, and healthcare system-related factors (Sabaté, 2003). Nonadherence, especially in cases like medication management, can lead to significant health risks and increased medical costs. For instance, nonadherence to diabetes medications can result in preventable complications and hospitalizations (Schwartz et al., 2017).
Research has shown that 50% of prescription drugs are either taken incorrectly or not at all, leading to 125,000 deaths annually and costing the healthcare system approximately $290 billion each year (Chesnow, 2014). Nonadherence is a critical issue that affects both patient outcomes and the financial burden on healthcare systems.
Locus of Control for Nursing Educators in Managing Noncompliance and Nonadherence
In the context of patient education, compliance and adherence often involve an element of control—the degree to which the educator or healthcare provider attempts to guide patient behavior. The concept of Locus of Control (LOC), introduced by Rotter (1954), refers to an individual’s belief about the source of control over life events, including health outcomes. This can be internal (belief that one controls their own destiny) or external (belief that external forces, such as fate or other people, control outcomes).
Health Locus of Control (HLOC), developed by Wallston et al. (1978), applies this concept to health behaviors. Internally controlled individuals believe they can influence their own health outcomes through actions like diet, exercise, or adherence to treatment. Externally controlled individuals believe their health is influenced by outside factors, such as luck, fate, or healthcare providers. For instance, an internal patient might say, “I can control my diabetes through diet and medication,” whereas an external patient might say, “There’s nothing I can do; my condition is out of my hands.”
Understanding a patient’s HLOC can guide educators in developing appropriate strategies. Internally oriented patients may respond better to educational interventions that empower them to take control of their health, while externally oriented patients may benefit more from structured support and clear instructions from healthcare professionals.
Dimensions of Noncompliance and Nonadherence
Combes and Feral (2011) expanded on the original concept of LOC by identifying four dimensions of HLOC that further explain the patient’s approach to health and compliance:
- Internal: Power and control over health outcomes come from within the individual, related to their personal abilities.
- Chance External: Health outcomes are believed to be the result of fate or chance.
- Others External: Friends, family, or social networks are perceived as having significant influence over health.
- Doctors External: The belief that doctors and healthcare providers have the ultimate control over health outcomes.
Studies have explored the impact of these dimensions on patient behavior. For example, Brincks et al. (2010) found that patients with a Doctors External HLOC (believing their doctor had control over their health) were more likely to trust and adhere to physician instructions. Similarly, Janowski et al. (2013) showed that all dimensions of HLOC were positively correlated with health-related behaviors, regardless of the patient’s specific condition.
Understanding these dimensions can help nurse educators tailor their teaching methods. For instance, patients with an internal HLOC might benefit from education that emphasizes personal responsibility and self-care, while patients with an external HLOC may require more hands-on support and guidance from healthcare professionals.
Conclusion
Noncompliance and nonadherence are complex behaviors influenced by a wide range of factors, including patient characteristics, social and economic conditions, and healthcare system dynamics. While noncompliance often carries a negative connotation, it is essential for nurse educators to approach these behaviors with sensitivity and understanding. By recognizing the role of Locus of Control in patient behavior, educators can develop more personalized and effective strategies to encourage adherence, ultimately improving patient outcomes and reducing the burden on healthcare systems. Through targeted education and support, noncompliance can be reframed not as a failure but as an opportunity for deeper engagement and learning.