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Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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Incredibly Banal Ideas Tarted Up In Fancy Dress

April 5th, 2007 at 3:11 am · Allan Showalter, MD · Public Health · 1 Comment


Cervantes at Stayin’ Alive blogs about public health & healthcare policy, areas of thought which may offer insight into patient compliance.

Theoretical Models of Health-Associated Behaviors

Two recent Stayin’ Alive posts, Why can’t you behave yourself? and
Sesquepedalianism in the service of truth are especially pertinent to adherence because they deal with theoretical models designed to explicate how and why individuals behave as they do regarding healthcare, including compliance and noncompliance with treatment.

My own contention has been and continues to be that such theories, however impressive on paper, are fundamentally flawed because they are implicitly or explicitly stipulate that individuals operate in an exclusively rational manner. In reality, if a purebred rational man ever existed, it was in a land far away and a time long ago. My more extended discussion of this topic can be found at Patient Behavior

Cervantes, who writes clearly, bluntly, and, sometimes, passionately, takes a congruent stance, albeit with less nuance, and offers an alternative behavioral hypothesis.

His feelings, for example, about the classical health behavior theories can be ascertained from this excerpt:

In order to get funding for a study or an intervention, you need to articulate a behavioral theory on which your project will be based. These theories are incredibly banal ideas tarted up in fancy dress — with names like the Health Beliefs Model, Theory of Reasoned Action, Social Learning Theory, and the powerhouse Transtheoretical Model, also known as Stages of Change.

Subtle, eh?

Regardless, these two posts are enlightening and entertaining. Further, while only the occasional post on this blog addresses compliance directly, many public health policies have an impact on which healthcare elements are made available and which hoops through which one has to jump before accessing that care, which, in turn, has an impact on compliance.


Tags: Public Health

1 response so far ↓

  • 1 Cervantes // Apr 5, 2007 at 9:16 am

    Thanks for the link. Since I use a pseudonym on my site I have the luxury of being undiplomatic at times about the scholarly world. Anyway, I would say that just because people aren’t “rational” decisionmakers in the health beliefs model sense, doesn’t mean they are irrational in a more philosophically sophisticated sense. It’s just that they have many concerns beyond actuarially maximizing their expected QALYs.