WHAT IS COMPLIANCE?
Haynes et al. (1979) defined compliance as ‘the extent to which the patient’s behaviour
(in terms of taking medications, following diets or other lifestyle changes) coincides
with medical or health advice’. Compliance has excited an enormous amount of clinical
and academic interest over the past few decades and it has been calculated that 3200
articles on compliance in English were listed between 1979 and 1985 (Trostle 1988).
Compliance is regarded as important primarily because following the recommendations
of health professionals is considered essential to patient recovery. However, studies
estimate that about half of the patients with chronic illnesses, such as diabetes and
hypertension, are non-compliant with their medication regimens and that even com-
pliance for a behaviour as apparently simple as using an inhaler for asthma is poor
(e.g. Dekker et al. 1992). Further, compliance also has financial implications as money
is wasted when drugs are prescribed, prescriptions are cashed, but the drugs not taken.
PREDICTING WHETHER PATIENTS ARE COMPLIANT: THE WORK OF LEY
Ley (1981, 1989) developed the cognitive hypothesis model of compliance. This claimed
that compliance can be predicted by a combination of patient satisfaction with the
process of the consultation, understanding of the information given and recall of this
information. Several studies have been done to examine each element of the cognitive
hypothesis model. This model is illustrated in Figure 4.1.
Patient satisfaction
Ley (1988) examined the extent of patient satisfaction with the consultation. He
reviewed 21 studies of hospital patients and found that 41 per cent of patients were
dissatisfied with their treatment and that 28 per cent of general practice patients were
dissatisfied. Studies by Haynes et al. (1979) and Ley (1988), found that levels of patient
Fig. 4-1 Ley’s model of complianceDOCTOR–PATIENT COMMUNICATION 77