Overview of Current Compliance Models
The No-Nonsense Summary
1. Current Compliance Models implicitly require patients to behave rationally for the models to operate properly
2. The requirement that patients behave rationally severely restricts the clinical utility of these models and theories
Theoretical Health Behavior Models And Patient Compliance
Several hypothetical models of healthcare compliance have been developed which are appealingly straightforward, logical, and internally consistent. Moreover, they seem to provide genuine insight into certain features of patients’ responses to healthcare recommendations. Yet, as already noted, their impact on routine clinical care has been negligible. This ineffectiveness, I propose, is secondary to an element common to all of these models: each of these hypothetical constructs postulates a patient who functions solely and invariably in a logical manner. Without such an individual, the models, however elegant, will not operate properly.
Three of the most influential models, The Health Belief Model, The Transtheoretical Model, and Learning Theory, provide illuminating examples of this notion.1
The Health Belief Model, is predicated on the ability of a rational individual to consciously weigh the advantages and disadvantages of a given behavior holds that the extent to which an individual will follow a healthcare recommendation is a function of his set of beliefs regarding that recommendation. According to this model, a patient will adhere to a treatment regimen if he believes the health problem being treated is significant, the prescribed treatment is likely help, and he (the patient) is able to implement the recommended course of action. The most common intervention based on this model is a discussion between the patient and the clinician of the pros and cons of undertaking the recommended behavior, followed by the patient’s decision regarding treatment.
The Transtheoretical Model‘s starting point is the assumption that health behavioral changes are the result of a logical process, which is divided into five stages:
The individual has yet to consider a change possible or needed
The individual grasps the problem and considers change
The individual plans to act on the change within the ensuing month
Contemplation and preparation are transformed into actual changes
The goal becomes sustaining behavioral change and resisting relapse
Learning Theory promotes an analogous methodology of breaking down complex healthcare-pertinent behavioral changes into small steps that can be sequentially established (learned) and reinforced.
Clearly, an absolute requirement for each of these theories, as it is for the other compliance models, is an individual who operates in a predominately logical manner. In fact, the intuitively assessed validity of these models correlates precisely with the degree of rationality one assigns to an imaginary patient; a convincing argument can be made that the ideal subject would be a rudimentary artificial intelligence machine – or Star Trek’s Dr. Spock. The implict goal of these theories appears to be assisting individuals who already operate on the basis of logical calculations make those calculations even more logically. That is no small accomplishment, nor is it irrelevant to compliance. It just isn’t enough. The nature and consequences of this logic-dependency are discussed in a later Section, Good Patients, Bad Patients, Economic Man, & Other Nonexistent Species. Before that, however, it is necessary to consider real world applications – the programs and tactics used to enhance compliance.
Next: Current Program Design
PDF Download: Current Models
The State Of The Art Section, which includes The Verdict, Current Models, Current Programs, and Patient Behavior subsections and all citations is available in PDF format for download at State Of The Art
- Caveat: The descriptions that follow are illustrative rather than complete and are not presented as well-rounded examinations. A more thorough, yet still succinct, summary of all the most important models can be found in Elder’s Theories and Intervention Approaches to Health-Behaviour Change.↩