Patient-by-treatment context interaction in chronic disease: a conceptual framework for the study of patient adherence.
OBJECTIVE
Previous reviews have concluded that there is little or no evidence supporting a predictable association between patient characteristics and regimen adherence in chronic illness. The primary objective of this article is to propose an alternative conceptual framework for the interpretation and design of adherence research.


METHODS
The author's research involving adherence among patients with end-stage renal disease is reviewed and used to illustrate the patient-by-context interactive framework.


RESULTS
Adherence is most favorable when the patient's characteristic or preferred style of coping with illness and treatment-related experiences is congruent with the contextual features or demands of the particular type of medical intervention the patient is undergoing. Among patients with end-stage renal disease, a more vigilant or active style of coping is associated with more favorable adherence only for patients undergoing home-based dialysis treatment modalities that are highly patient directed. Among patients receiving hospital-based, provider-controlled treatment, a less vigilant or more passive coping style is associated with more favorable dialysis regimen adherence.


CONCLUSIONS
The patient-by-context interactive perspective can provide a useful framework for the interpretation and design of adherence research.
Christensen
A J
AJ
Department of Psychology, University of Iowa, Iowa City 52242, USA. Alan-Christensen@uiowa.edu
D000223:Adaptation, Psychological; D002908:Chronic Disease; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010349:Patient Compliance; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D015430:Weight Gain