RELATING TO PATIENTS 235(1968) found that mothers who were very satisfied with their doctor’s warmth, concern
and communication were three times more likely to adhere than dissatisfied mothers.
Satisfaction depends upon the patient’s perception of the doctor’s sensitivity, concern,
respect and competence. Reducing waiting time, taking time to greet the patient in
a courteous manner and engaging in friendly introductory exchanges are all likely to
increase satisfaction. Asking open-ended questions that cannot be answered ‘yes’ or
‘no’ and allowing the patient time to express his or her worries is also likely to make
the patient feel satisfied with the consultation.
Given the importance of patient satisfaction it is interesting to note that doctors’
own satisfaction with work is a predictor of patients’ adherence. In a 2-year prospective
study, DiMatteo et al.(1993) found that, controlling for adherence at baseline, doctors’
satisfaction with their work was a significant predictor of patient’s future adherence
(r =.25). This study also showed that doctors’ self-reported willingness to answer all
their patients’ questions, regardless of the time involved was positively associated with
adherence. Doctors who are happier in their work may be more willing to answer
questions and may engender greater satisfaction in their patients. Thus patient
satisfaction may mediate the relationship between doctors’ job satisfaction and their
patients’ adherence.
The social context in which people live including the social support they receive
affects adherence. Indeed adherence may partially mediate the effect of social support
on health. In a meta-analysis summarizing 122 studies reporting associations between
social support and adherence, DiMatteo (2004) found that adherence (compared to non-
adherence) was 3.6 times more likely among those receiving practical support than
among those who did not have such support. Similarly, the risk of non-adherence was
1.35 times higher if patients were not receiving emotional support than if they were.
Practical support increases self-efficacy and actual control over adherence (see the theory
of planned behaviour and social cognitive theory – Chapter 8) thereby rendering
recommended changes feasible. A lack of social support may also increase stress levels,
which may, in turn, allow less priority for adherent goals (DiMatteo, 2004). This is
consistent with a recent study that explored factors associated with non-adherence to
medication among individuals with cardiovascular disease (Crowley et al., 2015). These
authors found that higher life chaos (or stress), worry about having a stroke or heart
attack and being younger predicted self-reported non-adherence to medication.
Can we improve adherence?
Available evidence suggests that we can improve adherence but that this may
require interventions including multiple change techniques. For example, in a meta-
analysis of 153 studies evaluating the effectiveness of interventions designed to improve
patient adherence, Roter et al.(1998) found that interventions significantly improved
adherence compared to control conditions with small to moderate effect sizes. The
researchers reached four conclusions. First, while effect sizes were small, interventions
were generally effective. For example, even the smallest effect size on measures of health
outcomes translated into a 10 per cent increase compared to no-intervention controls.
As Roter et al. (1998: 1150) note, a 10 per cent difference between an intervention
and control group could ‘save considerable cost and suffering’. Second, no particular
intervention approach worked better than any one other but combinations were more