chapter  1
4 Pages


Within the field of healthcare the terms ' compliance' and 'non -compliance ' refer to the extent to which patients follow (or not) the regimens recommended by their doctors . An enormous amount of research over several decades has shown consist­ ently that between one third and one half of patients do not follow their doctors' advice and in particular fail to take the medicines prescribed for them ( Carter, Taylor & Levenson 2003; Donovan 1 995 ; Donovan & Blake 1 992; Haynes & Sackett 1 979; Sackett & Haynes 1 976; Stimson 1 974; Trostle 1 998 ) . The manifest failure of so many patients to act in their own best interests has baffled the medical establish­ ment. No distinctive characteristics of non-compliant individuals have been established, and the range of illnesses eliciting non-compliant behaviour runs across the spectrum from trivial to life-threatening. In one study Rovelli et al. found that patient non-compliance with immunosuppressive drugs following organ transplant caused a higher incidence of graft loss than uncontrollable rej ection affecting patients who had adhered to treatment as prescribed. Eighteen per cent of renal transplant patients were found to be non-compliant with treatment and the maj ority ( 9 1 % ) of these subsequently experienced either organ rej ection or death. The comparable failure rate for compliant patients was 1 8 % (Rovelli et al. 1 989 ) . The high rates of 'non-compliance' among AIDS patients have also been well established ( Chesney, Morin & Sherr 2002; Wright 2000 ) . Thousands of studies of non-compliance and how to modify patient behaviour have been conducted over the last three decades . However, this enormous effort has made no discernible impact on the consistently high rates of reported non-adherence . The mismatch between medical prescription and patient behaviour has persisted, and manifests itself in many different forms (Box 1 . 1 ) .