Compliance and Adherence In Health Care Compliance and Adherence Concepts in Healthcare Behaviors
The terms compliance and adherence are central to healthcare and patient education. These concepts are often applied implicitly or explicitly in many health behavior models. In healthcare, compliance refers to the extent to which a patient follows medical advice, such as taking medications, adhering to prescribed diets, or making lifestyle changes. Adherence, however, emphasizes a more collaborative process, where patients agree with the treatment plan and actively participate in managing their health.
The nurse, as an educator, plays a key role in understanding the factors that influence patient behaviors and how to promote or hinder the acquisition and application of knowledge. Factors such as socioeconomic status, psychological well-being, and health literacy, among others, complicate the relationship between education and health outcomes. A well-designed educational program cannot succeed unless it addresses these factors, especially motivation, adherence, and the complex barriers to compliance that patients face.
Compliance and Adherence in Nursing Education
In nursing education, the concepts of compliance and adherence have nuanced differences. Compliance is often described as the extent to which a patient’s behavior aligns with healthcare advice (Sackett & Haynes, 1976). The term suggests a hierarchical dynamic between the healthcare provider and the patient, implying that the patient should “comply” with orders in a passive, submissive manner. This traditional view of compliance has been criticized for ignoring the patient’s autonomy and role in healthcare decision-making. Nurses and healthcare educators advocate for a patient-centered approach, where the patient’s values, beliefs, and choices are respected.
On the other hand, adherence is defined as the degree to which a patient follows a mutually agreed-upon plan of care (Sabaté, 2003). The key difference lies in the concept of agreement—patients and providers collaboratively create the treatment plan, and the patient is an active participant in their care. The World Health Organization (WHO) suggests that adherence is more patient-centered than compliance, as it reflects the patient’s commitment and involvement in treatment decisions.
For example, a patient with chronic sleep disturbances may initially comply with a medication regimen but may not adhere to it over time if they don’t perceive long-term benefits or encounter side effects. In this scenario, the patient may discontinue the treatment, even though they temporarily complied. This highlights the distinction between short-term compliance and long-term adherence, with adherence reflecting a deeper level of commitment.
During the 1990s, there was a shift in healthcare literature from the term compliance to adherence to reflect a more inclusive approach. Adherence respects the patient’s role in healthcare decision-making, moving away from the authoritative tone implied by compliance. Despite these differences, both terms are commonly used interchangeably in literature due to their overlapping goals—ensuring patients maintain health-promoting regimens (Brown & Bussell, 2011).
Nursing Educational Perspectives on Compliance Models
Various theories and models have been proposed to explain or describe compliance from multidisciplinary perspectives, including biomedical, behavioral, communication, and self-regulatory systems. These theories provide different lenses through which nurses and healthcare educators can understand and address compliance and adherence:
- Biomedical Theory: This theory links compliance with patient characteristics such as demographics, the severity of illness, and the complexity of the treatment regimen.
- Behavioral/Social Learning Theory: This theory focuses on external factors like rewards, cues, contracts, and social supports that influence patient behavior.
- Communication Models: These models examine the role of communication between the patient and healthcare provider in influencing compliance. This includes aspects like how information is sent, received, comprehended, and retained by the patient.
- Rational Belief Theory: This theory suggests that patients engage in a cost-benefit analysis, deciding to comply based on weighing the benefits of treatment against the risks of disease.
- Self-Regulatory Systems: This model views patients as problem solvers whose behavior is regulated by their perception of illness, cognitive skills, and past experiences. It emphasizes that patients actively plan and cope with illness based on their understanding.
Each of these models has its limitations, as no single model fully explains the complexity of compliance and adherence (Heiby et al., 2005; Munro et al., 2007). Recent efforts, such as the Health Compliance-II Model (Heiby et al., 2005), attempt to incorporate elements from multiple theories to provide a more comprehensive understanding of compliance.
Challenges in Achieving Compliance and Adherence
Achieving compliance and adherence is particularly challenging in the management of chronic diseases. Many patients struggle to maintain lifestyle changes or treatment regimens that offer long-term benefits without immediate gratification. For instance, individuals with chronic conditions like diabetes or hypertension may initially comply with dietary or medication changes but fail to adhere in the long run due to frustration with the slow or delayed outcomes.
Innovative tools, such as web-based behavior motivational tools, have been developed to improve patient compliance by integrating social cognitive theories and using gaming techniques to make behavior change more engaging (Lin et al., 2013). These tools create scenarios and interventions to encourage patients to follow their treatment regimens effectively.
Conclusion
Understanding the concepts of compliance and adherence is crucial for healthcare providers, especially nurse educators, who play a vital role in guiding patients through the complexities of managing their health. While compliance often implies a hierarchical relationship between patient and provider, adherence emphasizes a collaborative, patient-centered approach. Both concepts, however, remain central to measuring health outcomes and ensuring that patients engage in health-promoting behaviors.
Various theories and models attempt to explain compliance, and while each offers valuable insights, no single theory has been proven universally superior. A multivariate approach—incorporating elements from biomedical, behavioral, communication, and self-regulatory models—may provide the most comprehensive understanding of why patients adhere or fail to adhere to treatment.
By incorporating these perspectives into nursing education, healthcare professionals can better equip themselves to address patient noncompliance and nonadherence. This will ultimately lead to improved patient outcomes and a more effective healthcare system.