Diabetes Care, Vol 22, Issue 4 635-639, Copyright © 1999 by American Diabetes Association

ARTICLES

Beyond "compliance" is "adherence". Improving the prospect of diabetes care

KE Lutfey and WJ Wishner
Department of Sociology, Bloomington, Indiana University, Indianapolis, USA. klutfey@indiana.edu

The purpose of this study is to evaluate existing research in the area of patient "compliance," to endorse reconceptualizing "compliance" in terms of "adherence," and to discuss the benefits of such a change for medical practitioners. This study critically reviews existing medical, nursing, and social scientific research in the area of patient "compliance." We assert that the literature reviewed is flawed in its focus on patient behavior as the source of "noncompliance," and neglects the roles that practitioners, the American medical system, and patient-practitioner interaction play in medical definitions of "compliance." The term "compliance" suggests a restricted medical-centered model of behavior, while the alternative "adherence" implies that patients have more autonomy in defining and following their medical treatments. We suggest that while the change in terminology is minor, it reflects an important paradigmatic shift for thinking about the delivery of health care. By enabling practitioners to more accurately identify patients' social and economic constraints and to provide them with more efficient educational and financial resources, this type of change will improve patient care. In general, by moving to a more social paradigm for understanding patient behavior, practitioners can expand the types of explanations, and therefore the types of solutions, they have for therapeutic adherence.
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