Adherence and Communication

by

Morgan Snyder, Kelly Haskard-Zolnierek

• LAST REVIEWED: 25 July 2023
• LAST MODIFIED: 25 July 2023
• DOI: 10.1093/obo/9780199756841-0220

Introduction

Patient adherence is the extent to which an individual follows the treatment regimen that was prescribed during a medical visit. It is estimated that 25 percent to 50 percent of patients are nonadherent, with varying rates across different conditions and treatment regimens. Nonadherence is a widespread problem and can negatively influence health outcomes, including disease progression and worsening of symptoms. In addition to negatively influencing health, nonadherence can also be costly. It is estimated that several hundred billion dollars spent on health care annually in the United States is due to nonadherence. Many different factors play into whether a patient is adherent, including complexity of the regimen, side effects, mental health, level of social support, and cost. A significant factor that is known to influence adherence is the quality of provider-patient communication. Health-care providers play an important role in promoting adherence for their patients, through educating patients about their disease and regimens, sharing decisions about the course of treatment with the patient, conveying the important implications of adherence, and providing support when patients face barriers to adherence. Communication during the medical visit plays an important role in determining whether a patient will adhere. This article will provide an overview of the literature on communication and adherence, focusing on topics such as information giving, shared decision making, nonverbal communication, trust, empathy, patient-centered communication, and health literacy.

General Overviews

The works in this section provide overviews of the literature on provider-patient communication and adherence. The meta-analysis Haskard-Zolnierek and DiMatteo 2009 provides an overview of and establishes the relationship between communication and adherence across the literature. Haskard-Zolnierek and Thompson 2016 provides an overview of communication and adherence, focusing on many facets of communication. DiMatteo, et al. 2012 gives suggestions to providers to enhance adherence and provides an overview of communication behaviors that can improve adherence. Martin, et al. 2010 discusses over half a decade of empirical research on the topic combined with insights for practitioners in the field.

• DiMatteo, M. Robin, Kelly B. Haskard-Zolnierek, and Leslie R. Martin. 2012. Improving patient adherence: A three-factor model to guide practice. Health Psychology Review 6.1: 74–91.

  DOI: 10.1080/17437199.2010.537592

  Provides recommendations to providers to promote adherence. The first recommendation includes giving patients the information and support they need to adhere, including encouraging them to participate in decision making, listening to them, and building empathy and trust. The second recommendation includes motivating the patient to adhere through addressing factors that might influence their beliefs about their treatment. The third involves addressing barriers to adherence that might arise.

• Haskard-Zolnierek, Kelly B., and M. Robin DiMatteo. 2009. Physician communication and patient adherence to treatment: A meta-analysis. Medical Care 47.8: 826–834.

  DOI: 10.1097/MLR.0b013e31819a5acc

  This meta-analysis shows that across 106 studies there is a strong, positive relationship between communication and adherence. This meta-analysis also shows that patients are about two times more likely to adhere if their physician has good communication skills.

• Haskard-Zolnierek, Kelly, and Teresa L. Thompson. 2016. Adherence and communication. In Oxford Bibliographies in Communication. Edited by Patricia Moy. New York: Oxford Univ. Press.

  Provides an overview of communication and adherence with topic areas including provider-patient communication and adherence, shared decision making, language use, nonverbal communication, and interventions to improve adherence through communication, including communication skills training.

• Martin, Leslie R., Kelly B. Haskard-Zolnierek, and M. Robin DiMatteo. 2010. Health behavior change and treatment adherence: Evidence-based guidelines for improving healthcare. New York: Oxford Univ. Press.

  This book describes the Information-Motivation-Strategy Model of adherence and includes several chapters on communication, collaboration, and partnership between patients and their health-care providers. The book is written for health-care professionals and students in various health-care fields and provides practical strategies and techniques to support patients in their efforts to adhere.