Improving patient adherence: A three-factor model to guide practice

Patient nonadherence is widespread and costly. This paper provides a brief narrative review of research on (non)adherence and validates a clinically useful three-factor heuristic model to guide practitioners as they work with patients to improve adherence. This model is based on the most stable findings from meta-analyses and large-scale empirical studies, reflects the realities of medical practice and offers recommendations for assessing and enhancing patient adherence, particularly in chronic disease management. The model comprises three important clinical actions: (1) insuring that patients have the right information and know how to adhere - including listening to patients' concerns, encouraging their participation and partnership in decision-making, building trust and empathy, and enhancing recall; (2) helping patients believe in their treatment and become motivated to commit to it - that is, addressing the cognitive, social, cultural normative and contextual factors that affect patients' beliefs, attitudes and motivation; and (3) assisting patients to overcome practical barriers to treatment adherence and develop a workable strategy for long-term disease management - including assessing and enhancing patients' social support, identifying and treating their depression and helping patients overcome cost-related treatment barriers.