ABSTRACT

The goal of our chapter is to elaborate a model of the cognitive and emotional factors affecting adherence. In doing so, we examine the ways in which age-related increases in morbidity and age-related changes in an individual’s psychological functioning affect the self-regulation processes responsible for caring for oneself and adherence to treatment regimens. It is important to recognize that adherence is an important topic in medicine and sociology as well as psychology and that each of these disciplines approaches the issue somewhat differently (for earlier reviews of these perspectives see H.Leventhal & Cameron, 1987, and H.Leventhal, Zimmerman, & Gutmann, 1984). For example, medicine’s concerns are typically of two types: (a) adherence is important for successful management of disease, and (b) adherence is critical for evaluating treatment efficacy in clinical trials because differences in adherence can reduce or even reverse the relative efficacy of two medications if adherence is less to the more effective of the two (Feinstein, 1976). Medical sociologists, on the other hand, have been concerned with the effects of institutions, social class, and roles on adherence, addressing questions such as: “Is there differential access and adherence to treatment as a function of education and/or income?” “Is adherence different in managed care and fee-for-service practice?” “Does continuity of care affect doctor-patient relationships and adherence?”