[From Kenny Kitzke (2003.12.07)]
Hi Roland. Welcome to CSGNet. You have asked a great question.
Our convention on this Net is to use a header that identifies who is speaking and when. This not only helps understanding and reduces confusion in this one-way medium, it also helps in archive purposes.
In a message dated 12/7/2003 12:43:20 PM Eastern Standard Time, office@ROLANDERNST.COM writes:
In my research about doctor-patient relationship and adherence I found out
that one main factor of the unpredictability of adherence is that a lot of
research is done without paying attention to the patients knowledge,
ability, purpose etc. Since in this group there are a lot of psychologists
this isn´t new for you.
At the moment I am lookong for a good model to predict adherence. There is
the health-belief model and the theory of planned behavior which seem to me
the most promissing.
I also seached Psycinfo and Medline for HPCT or PCT Models for compliance or
adherence but I couldn`t find any. Does anybody of you know a good PCT model
for adherence or compliance?
Thank you in advance for your help
Terms like “adherence” or “compliance” are not a part of the PCT/HPCT model or theory and explains the lack of search linkage. Nor is the model very useful in predicting the future actions of people. But, that does not mean the concept or phenomena is not addressed by the theory.
My own belief is that this is one of the strongest benefits of learning this radically new theory of behavior. Most theories of behavior use a stimulus-response model where we seach for a stimulus (doctor’s therapy) that will be responded to carefully by a patient (adherence) to hopefully produce a result that both the doctor and the patient seek.
PCT/HPCT explains quite well why adherence is so disappointing and unpredictable. Basically, other goals internal to the patient interfere or conflict with the doctor’s therapy instructions given to the patient. When the patient controls his own internal perceptions, the behavior does not comply with what the doctor ordered or what the patient wanted at the time of action.
No doctor can understand all the possible desires that reside within the mind and spirit of the patient. Sometimes the patient’s preferences align in a way where adhering to the doctor’s therapy is also what the doctor ordered. It creates an illusion that the doctor can give a therapy in a way that causes the patient to adhere all the time.
PCT/HPCT recognizes this is NOT what is going on and is an illusionary goal. That does not mean that certain ways of doctors prescribing therapy are not more likely to be adhered to than others. But, 100% of the patients, 100% of the time. Well, that is highly unlikely. And predicting which patients will or will not comply in advance is also highly unlikely.
What PCT/HPCT predicts is that people will ALWAYS use various means (actions) to achieve the perceptions they select for control. When they have a goal that conflicts in real time from the doctor’s generalized therapy goal, the behavior the doctor hopes for will not occur. And this could be a significant fraction of the time no matter how well the doctor does his job of prescribing the therapy.
What doctor’s could do to help adherence in patient’s is to insure the patient has adopted the therapy goals and will control for them at a high level of attention and determination (something we PCTers would call “gain” in the circular control circuit used in all behavior.)
Well, that is a few thoughts off the top of my head. Perhaps others could explain more to you and better? Or, perhaps you have some other questions?