Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations

Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individual noncompliance with health and medical advice. While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patient, regimen, or illness which, unfortunately, are usually neither predictive nor alterable. This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance. The review suggests that certain health beliefs (especially personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence are the most productive dimensions for present intervention and further exploration. Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior. Further research should, with standardized questionnaires and analysis techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance.