Non-adherence — defined as the extent to which patients do not take medications as prescribed by their health care provider — is one of the most serious obstacles of chronic disease care. Its average prevalence across various conditions is as high as 50% (Brown & Bussell, 2011; De Geest & Sabaté, 2003). Regarding the terminology of medication taking the word “compliance” suggests that the patients are expected to follow the doctors’ instructions, while “adherence” is a more neutral expression. The most recent term “concordance” evokes the notion of equity and partnership in the physician-patient relationship (Blenkinsopp et al., 1997; Pound et al., 2005). As the connotations of these terms differ, in the present work I will stick to the neutral
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In particular, we can differentiate non-adherence typologies based on, among others, 1. the set of the behaviors it involves, 2. the extent of non-adherence, 3. the phase of treatment when it occurs as well as 4. the motivational background. On the behavioral level, there are many different markers of non-adherence, such as modifying the prescription drug dosage (i.e. taking more or less medication than prescribed), combining medications, altering the dose interval, skipping dosages, etc. (Wunsch et al., 2014) (Issues & Medicine, 2013). Regarding the extent of non-adherence, it is often treated as a dichotomous variable (adherent versus non-adherent), but a more realistic approach would probably be to add the category of partial non-adherence (Mitchell, 2006). Concerning the phase of the medical treatment, we can distinguish screening, follow-up, and treatment non-adherence (Vermeire, Hearnshaw, Van Royen, & Denekens, 2001). Another categorization differentiate between non-adherence in phases of initiation, implementation or discontinuation of the treatment (Vrijens et al., 2012). Moreover, a distinction has to be made between intentional and unintentional forms of non-adherence (e.g.: Atkins & Fallowfield, 2006; Brus, Van De Laar, Taal, Rasker, & Wiegman, 1999; Kjeldsen et al., 2011; Mo & Mak, 2009). Unintentional non-adherence refers to behaviors
In particular, we can differentiate non-adherence typologies based on, among others, 1. the set of the behaviors it involves, 2. the extent of non-adherence, 3. the phase of treatment when it occurs as well as 4. the motivational background. On the behavioral level, there are many different markers of non-adherence, such as modifying the prescription drug dosage (i.e. taking more or less medication than prescribed), combining medications, altering the dose interval, skipping dosages, etc. (Wunsch et al., 2014) (Issues & Medicine, 2013). Regarding the extent of non-adherence, it is often treated as a dichotomous variable (adherent versus non-adherent), but a more realistic approach would probably be to add the category of partial non-adherence (Mitchell, 2006). Concerning the phase of the medical treatment, we can distinguish screening, follow-up, and treatment non-adherence (Vermeire, Hearnshaw, Van Royen, & Denekens, 2001). Another categorization differentiate between non-adherence in phases of initiation, implementation or discontinuation of the treatment (Vrijens et al., 2012). Moreover, a distinction has to be made between intentional and unintentional forms of non-adherence (e.g.: Atkins & Fallowfield, 2006; Brus, Van De Laar, Taal, Rasker, & Wiegman, 1999; Kjeldsen et al., 2011; Mo & Mak, 2009). Unintentional non-adherence refers to behaviors