Journal of Behavioral Medicine

, Volume 10, Issue 4, pp 377–394 | Cite as

Determinants of adherence to medical regimens by hypertensive patients

  • Annette L. Stanton


This study employed multivariate analyses and structural modeling procedures to examine a model for the determinants of adherence to medical regimens. Fifty adult hypertensive patients at a health maintenance organization completed questionnaires and participated in home interviews over a 10-week period. Knowledge of medical regimens, information communication between the patient and the medical professionals, satisfaction with health-care providers, health locus of control, social support, and treatment disruption to life-style were assessed. Adherence was assessed through self-report and behavioral (i.e., pill-count ratio, percentage of kept medical appointments) indices. Finally, repeated blood-pressure measurements were obtained. Structural modeling procedures revealed that greater expectancy for internal control over health and hypertension, greater knowledge of the treatment regimen, and stronger social support were significant determinants of adherence; in turn, higher levels of adherence facilitated blood-pressure reduction.

Key words

Adherence compliance hypertension medical regimens blood pressure 


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  1. Becker, M. H. (1979). Understanding patient compliance: The contributions of attitudes and other psychosocial factors. In Cohen, S. J. (ed.),New Directions in Patient Compliance, D. C. Heath, Lexington, Mass., pp. 1–32.Google Scholar
  2. Becker, M. H., and Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care regimens.Med. Care 13: 10–24.PubMedGoogle Scholar
  3. Becker, M. H., and Maiman, L. A. (1980). Strategies for enhancing patient compliance.J. Commun. Health 6: 113–135.Google Scholar
  4. Bender, P. M., and Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures.Psychol. Bull. 88: 588–606.CrossRefGoogle Scholar
  5. Caplan, R. D., Robinson, E. A. R., French, J. R. P., Caldwell, J. R., and Shinn, M. (1976).Adhering to Medical Regimens: Pilot Experiments in Patient Education and Social Support, Institute for Social Research, Ann Arbor, Mich.Google Scholar
  6. Caplan, R. D., Harrison, R. V., Wellons, R. V., and French, J. R. P. (1980).Social Support and Patient Adherence: Experimental and Survey Findings, Institute for Social Research, Ann Arbor, Mich.Google Scholar
  7. Cromwell, R. L., Butterfield, E. C., Brayfield, F. M., and Curry, J. L. (1977).Acute Myocardial Infarction: Reaction and Recovery, Mosby, St. Louis, Mo.Google Scholar
  8. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests.Psychometrika 16: 297–334.Google Scholar
  9. Davis, M. S. (1966). Variations in patients' compliance with doctors' orders: Analysis of congruence between survey responses and results of empirical investigations.J. Med. Educ. 41: 1037–1048.PubMedGoogle Scholar
  10. Epstein, L. H., and Cluss, P. A. (1982). A behavioral medicine perspective on adherence to long-term medical regimens.J. Consult. Clin. Psychol. 50: 950–971.PubMedGoogle Scholar
  11. Garrity, T. F. (1981). Medical compliance and the clinician-patient relationship: A review.Soc. Sci. Med. 15E: 215–222.Google Scholar
  12. Haynes, R. B. (1976). A critical review of the “determinants” of patient compliance with therapeutic regimens. In Sackett, D. L. and Haynes, R. B. (eds.),Compliance with Therapeutic Regimens, Johns Hopkins University Press, Baltimore, Md., pp. 26–39.Google Scholar
  13. Haynes, R. B. (1979). Strategies to improve compliance with referrals, appointments, and prescribed medical regimens. In Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore, Md., pp. 121–143.Google Scholar
  14. Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.) (1979).Compliance in Health Care, Johns Hopkins University Press, Baltimore, Md.Google Scholar
  15. Howe, G. W. (1981).Evaluating a Medical Consumer Assertion Training Program: Effects on Patient-Physician Interaction and Compliance with Therapeutic Regimen, Unpublished doctoral dissertation, University of Connecticut, Storrs.Google Scholar
  16. Hulka, B. S. (1979). Patient-clinician interactions and compliance. In Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore, Md., pp. 63–77.Google Scholar
  17. Janz, N. K., and Becker, M. H. (1984). The health belief model: A decade later.Health Educ. Q. 11: 1–47.PubMedGoogle Scholar
  18. Jöreskog, K. G., and Sörbom, D. (1983).LISREL V and VI-Analysis of Linear Structural Relationships by Maximum Likelihood and Least Squares Methods, International Educational Services, Chicago.Google Scholar
  19. Kirscht, J. P., and Rosenstock, I. M. (1979). Patients' problems in following recommendations of health care experts. In Stone, G. C., Cohen, F., and Adler, N. E. (eds.),Health Psychology, Jossey-Bass, San Francisco, pp. 189–215.Google Scholar
  20. Laughlin, K. D., Sherrard, D. J., and Fisher, L. (1980). Comparison of clinic and home blood pressure levels in essential hypertension and variables associated with clinic-home differences.J. Chron. Dis. 33: 197–206.PubMedGoogle Scholar
  21. Leventhal, H., Zimmerman, R., and Gutmann, M. (1984). Compliance: A self-regulation perspective. In Gentry, W. D. (ed.),Handbook of Behavioral Medicine, Guilford Press, New York, pp. 369–436.Google Scholar
  22. Ley, P. (1977). Psychological studies of doctor-patient communication. In Rachman, S. (ed.),Contributions to Medical Psychology, Pergamon Press, New York, pp. 9–42.Google Scholar
  23. Masur, F. T. (1981). Adherence to health care regimens. In Prokop, C. K., and Bradley, L. A. (eds.),Medical Psychology: Contributions to Behavioral Medicine, Academic Press, New York, pp. 441–470.Google Scholar
  24. Sackett, D. L., and Snow, J. C. (1979). The magnitude of compliance and noncompliance. In Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore, Md., pp. 11–22.Google Scholar
  25. Sackett, D. L., Haynes, R. B., Gibson, E. S., and Johnson, A. (1976). The problem of compliance with antihypertensive therapy.Pract. Cardiol. 2: 35–39.Google Scholar
  26. Seeman, M., and Evans, J. W. (1962). Alienation and learning in a hospital setting.Am. Social. Rev. 27: 772–783.Google Scholar
  27. Strahan, R., and Gerbasi, K. (1972). Short, homogeneous version of the Marlowe-Crowne social desirability scale.J. Clin. Psychol. 28: 191–193.Google Scholar
  28. U. S. Department of Health, Education, and Welfare (1979).Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, DHEW (PHS) Publ. No. 79-55071, U.S. Government Printing Office, Washington, D.C.Google Scholar
  29. Wallston, K. A., Wallston, B. S., and DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales.Health Educ. Monogr. 6: 160–170.PubMedGoogle Scholar
  30. Ware, J. E., Kane, R. L., and Davies-Avery, A. (1978). Effects of differences in quality of care on patient satisfaction and other variables: An experimental simulation. Paper presented at the 17th Annual Conference on Research in Medical Education, New Orleans, October.Google Scholar
  31. Weinstein, M. C., and Stason, W. B. (1976).Hypertension: A Policy Perspective, Harvard University Press, Cambridge, Mass.Google Scholar
  32. Witenberg, S. H., Blanchard, E. B., Suls, J., Tennen, H., McCoy, G., and McGoldrick, M. D. (1983). Perceptions of control and causality as predictors of compliance and coping in hemodialysis.Basic Appl. Soc. Psychol. 4: 319–336.Google Scholar
  33. Wolf, M. H., Putnam, S. M., James, S. A., and Stiles, W. B. (1978). The medical interview satisfaction scale: Development of a scale to measure patient perceptions of physician behavior.J. Behav. Med. 1: 391–401.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1987

Authors and Affiliations

  • Annette L. Stanton
    • 1
  1. 1.Department of Psychology, 4082 Haley CenterAuburn UniversityAuburn

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