, Volume 19, Issue 3, pp 239-263

Compliance with cardiovascular disease prevention strategies: A review of the research

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The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.

Preparation of this manuscript was supported in part by a Graduate Student Research Fellowship from the American Heart Association, PA Affiliate and by Grant R03 HS08891 from the DHHS, PHS, Agency for Health Care Policy and Research to L. E. Burke, Ph. D., R. N.; Grant U01 HL48992 from the National Heart, Lung, and Blood Institute and Grant 5 P30 NR03924-02 from the National Institute of Nursing Research to J. Dunbar-Jacob, Ph.D., R.N.; and Grant R01 0419-01 from the National Institute of Nursing Research to M. N. Hill, Ph. D., R. N.
The authors gratefully acknowledge the excellent assistance of Ruth Kadoch-Perry, B. S., B. S. N., R. N. in the preparation of this manuscript.