Journal of Behavioral Medicine

, Volume 25, Issue 4, pp 355–372 | Cite as

Intentional and Unintentional Nonadherence: A Study of Decision Making

  • Abigail L. Wroe
Article

Abstract

Nonadherence to medical regimens is a major problem in health care. Distinguishing between intentional nonadherence (missing/altering doses to suit one's needs) and unintentional nonadherence (forgetting to take medication) may help in understanding nonadherence. Participants with respiratory conditions completed an anonymous questionnaire about (i) nonadherence; (ii) reasons for and against taking medications; and (iii) perceived style of the consultation in which their medication was first prescribed, as well as demographic and clinical variables. Consistent with the hypotheses, intentional nonadherence is predicted by the balance of individuals' reasons for and against taking medication as suggested by the Utility Theory, where these reasons include only those which the individual considers relevant and on which he/she focuses. Unintentional nonadherence is less strongly associated with decision balance, and more so with demographics. The research highlights the importance of (a) treating intentional and unintentional nonadherence as separate entities and (b) assessing individuals' idiosyncratic beliefs when considering intentional nonadherence.

intentional nonadherence unintentional nonadherence decision making asthma consultation style 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Beaver, K., Luker, K. A., Owens, R. G., Leinster, S. J., and Degner, L. F. (1996). Treatment decison making in women newly diagnosed with breast cancer. Cancer Nurs. 19: 8–19.Google Scholar
  2. Becker, M. H., Drachman, R. H., and Kirscht, J. P. (1974). A new approach to explaining the sick-role behaviour in low-income populations. Am. J. Public Health 64: 205–216.Google Scholar
  3. Becker, M. H., Glanz, K., Sobel, E., Mossey, J., Zinn, L., and Knott, K. A. (1986). A randomized trial of special packaging of antihypertensive medications. J. Fam. Pract. 22: 357–361.Google Scholar
  4. Bosley, C. M., Fosbury, J. A., and Cochrane, G.M. (1995). The psychological factors associated with poor compliance with treatment in asthma. Eu. Respir. J. 8: 889–904.Google Scholar
  5. Brownbridge, G., and Fielding, D.M. (1991). Psychological adjustment and adherence to dialysis treatment regimens. Pediatr. Nephrol. 8: 744–749.Google Scholar
  6. Brownlee-Duffeck, M., Peterson, L., Simonds, J. F., Goldstein, D., Kilo, C., and Hoette, S. (1987). The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus. J. Consul. Clin. Psychol. 55: 139–144.Google Scholar
  7. Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., and McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 19: 124–133.Google Scholar
  8. Chambers, C. V., Markson, L., Diamond, J. J., Lasch, L., and Berger, M. (1999). Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices. Respir. Med. 93: 88–94.Google Scholar
  9. Cochrane, M. G., Mohan, V. B., Downs, K. E., Mauskopf, J., and Ben-Joseph, R. H. (2000). Inhaled corticosteroids for asthma therapy: Patient compliance, devices and inhalation technique. Chest 117: 542–550.Google Scholar
  10. Conner, M., and Norman, P. (1996). Predicting Health Behaviour, Open University Press, Buckingham, England.Google Scholar
  11. Coons, S. J., Sheahan, S. L., Martin, M. S., Hendricks, J., Robbins, C. A., and Johnson, J. A. (1994). Predictors of medication noncompliance in a sample of older adults. Clin. Ther. 16: 110–117.Google Scholar
  12. Csajkowski, D. R., and Koocher, G. P. (1987). Medical compliance and coping with cystic fibrosis. J. Child Psychol. Psychiatry 28: 311–319.Google Scholar
  13. Cummings, K. M., Becker, M. H., and Kirscht, J. P. (1981). Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients. J. Behav. Med. 4: 111–127.Google Scholar
  14. Degner, L. F., and Sloan, J. A. (1992). Decision making during serious illness: What role do patients really want to play. J. Clin. Epidemiol. 45: 941–950.Google Scholar
  15. DiMatteo, M. R., Sherbourne, C. D., Hays, R. D., et al. (1993). Physician's characteristics infuence patients' adherence to medical treatment: Results from the medical outcomes study. Health Psychol. 12: 93–102.Google Scholar
  16. Donovan, J. L. (1995). Patient decision making: The missing ingredient in compliance research. J. Technol. Assessm. Health Care 11: 443–455.Google Scholar
  17. Donovan, J. L., and Blake, D. R. (1992). Patient non-compliance: Deviance or reasoned decision-making. Soc. Sci. Med. 34: 507–513. Decision Making and Adherence 371Google Scholar
  18. Fallowfield, L. J., Hall, A., Maguire, P., Baum, M., and A'Hern, R. P. (1994). Psychological effects of being offered choice of surgery for breast cancer. BMJ 309: 448 (see comments).Google Scholar
  19. Fallowfield, L. J., Maguire, G. P., and Baum, M. (1990). Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ 301: 575–580.Google Scholar
  20. Fincke, B. G., Miller, D. T., and Spiro, A. (1998). The interaction of patient perception of overmedication with drug compliance and side effects. J. Genet. Intern. Med. 13: 182–185.Google Scholar
  21. Hand, C. H., and Bradley, C. (1996). Health beliefs of adults with asthma: Toward an understanding of the difference between symptomatic and preventive use of inhaler treatment. J. Asthma 33: 331–338.Google Scholar
  22. 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 Press, Baltimore.Google Scholar
  23. Haynes, R. B., McKibbon, K. A., Kanani, R., Brouwers, M. C., and Oliver, T. (1997). Interventions for helping patients follow prescriptions for medications. In Bero, R., Grill, J., Grimshw, J., and Oxman, A. (Eds.), Cochrane Collaboration on Effective Professional Practice Module, of the Cochrane Database Systematic Reviews, Update Software, Oxford.Google Scholar
  24. Haynes, R. B., Taylor, D. W., and Sackett, D. L. (1979). Compliance in Health Care, Johns Hopkins Press, Baltimore.Google Scholar
  25. Hershey, J. C., and Baron, J. (1987). Clinical reasoning and cognitive processes. Med. Dec. Making 7: 203–211.Google Scholar
  26. Horne, R. (1993). One to be taken as directed: Reflections on non-adherence (non-compliance). J. Soc. Admin. Pharm. 10: 150–156.Google Scholar
  27. Horne, R., and Weinman, J. (1999). Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J. Psychosom. Res. 47: 555–567.Google Scholar
  28. Horne, R., Weinman, J., and Hankins, M. (1999). The Beliefs About Medicines Questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol. Health 14: 1–24.Google Scholar
  29. Kaplan, R. M., and Simon, H. J. (1990). Compliance in medical care; reconsideration of self-predictions. Ann. Behav. Med. 12: 66–71.Google Scholar
  30. Ley, P. (1977). Psychological studies of doctor–patient communication. In Rachman, S. (Ed.), Contributions to Medical Psychology, Vol. 1, Pergamon, Oxford, UK, pp. 9–42.Google Scholar
  31. Ley, P. (1988). Communicating With Patients, Crume Helm, London.Google Scholar
  32. Marinker, M. (1997). Personal paper: Writing prescriptions is easy. BMJ 341: 747–748.Google Scholar
  33. Meyer, D., Leventhal, H., and Gutman, M. (1985). Common-sense models of illness: The example of hypertension. Health Psychol. 4: 115–135.Google Scholar
  34. Morgan, M., and Watkins, C. J. (1988): Managing hypertension: Beliefs and responses to medication among cultural groups. Soc. Health Illness 10: 561–578.Google Scholar
  35. Morisky, D. E., Green, L. W., and Levine, D. M. (1986): Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care 24: 67–74.Google Scholar
  36. National Institute of Health, Heart, Lung, and Blood Institute (1997). Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma, Public Health Service, Bethesda, MD.Google Scholar
  37. O'Brien, M.K., Petrie, K., and Raeburn, J. (1992). Adherence to medication regimens: Updating a complex medical issue. Med. Care Rev. 49: 435–454.Google Scholar
  38. Radolf, L. S., and Locke, B. Z. (1986). The community mental health assessment survey and the CES-D scale. In Weissman, M. M., Myers, J. K., and Ross, C. E. (Eds.), Community Surveys of Psychiatric Disorders, Rutgers University Press, New Brunswick, NJ.Google Scholar
  39. Rand, C. S., and Wise, R.A. (1994). Measuring adherence to asthma medication regimens. Am. J. Respir. Crit. Care Med. 149: 69–78.Google Scholar
  40. Rosenstock, I. (1974). The health belief model and preventive behaviour. Health Educ. Monogr. 2: 354–386.Google Scholar
  41. Sloan, J. A., Doig, W., and Yeung, A. (1994). A Manual to Carry out Thurstone Scaling and Related Analytic Procedures, University of Manitoba, Manitoba. 372 WroeGoogle Scholar
  42. Spector, S. L., Kinsman, R., Mawhinney, H., et al. (1986). Compliance of patients with asthma with an experimental aerolized medication; implications for controlled clinical trials. J. Allergy Clin. Immunol. 77: 65–70.Google Scholar
  43. Spielberger, C. D. (1983). Manual for the State-Trait Inventory STAI (Form Y), Consulting Psychologists Press, Palo Alto, CA.Google Scholar
  44. Stiggelbout, A. M., and Kiebert, G. M. (1997). A role for the sick role: Patient preferences regarding information and participation in clinical decision-making. Can. Med. Assoc. J. 157: 383–394.Google Scholar
  45. Sutherland, H. J., Llewellyn-Thomas, H. A., Lockwood, G. A., and Tritchler, D. L. (1989). Cancer patients: Their desire for information and participation in treatment decisions. J. R. Soc. Med. 82: 260–263.Google Scholar
  46. van Es, S., le Coq, E., Brouwer, M. A., Mesters, I., Nagelkerke, A. F., and Colland, V. T. (1998). Adherence-related behavior in adolescents with asthma: Results from focus group interviews. J. Asthma 35: 637–646.Google Scholar
  47. von Neumann, J., and Morgenstern, O. (1947). Theory of Games and Economic Behaviour, 2nd Ed., Princeton University Press, Princeton, NJ.Google Scholar
  48. Woller, W., Kruse, J., Winter, P., Mans, E. J., and Alberti, L. (1993). Cortisone image and emotional support by key figures in patients with bronchial asthma. Psychother. Psychosom. 59: 190–196.Google Scholar
  49. Wroe, A. L., and Salkovskis, P.M. (2000). The Effects of “non-directive” questioning on an anticipated decision whether to undergo predictive testing for heart disease: An experimental study. Behav. Res. Ther. 38: 389–403.Google Scholar
  50. Wroe, A. L., Salkovskis, P. M., and Rimes, K. A. (1998). The prospect of predictive testing for personal risk: Attitudes and decision making. Behav. Res. Ther. 36: 599–619.Google Scholar
  51. Wroe, A. L., Salkovskis, P. M., and Rimes, K. A. (2000). The effect of nondirective questioning on women's decisions whether to undergo bone density screening: An experimental study. Health Psychol. 19: 181–191.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Abigail L. Wroe
    • 1
  1. 1.Department of Psychology, Tamaki CampusUniversity of AucklandAucklandNew Zealand

Personalised recommendations