ABSTRACT
There have been dramatic advances in our knowledge regarding the treatment and prevention of many chronic diseases such as obesity, diabetes, heart disease, and various forms of cancer. However, the rates of many of these illnesses continue to rise, particularly among minority and vulnerable populations(1–4). There is a considerable gap between the findings from efficacy studies of interventions targeting many of those chronic diseases and the findings from effectiveness studies (5, 6). Treatment and prevention programs with high efficacy in a tightly controlled clinical trial with strict inclusion/exclusion criteria and significant resources for implementation are often ineffective when tested under real-world circumstances. Some researchers attribute this ineffectiveness to reluctance or inability of individuals to properly and thoroughly follow the recommendations of the medical and public health professionals, a phenomenon generally known as noncompliance or nonadherence (7). Others consider the inability of the health care system and our broader sociopolitical culture to adequately reach and affect over time the behaviors, organizations, and policies that facilitate compliance or adherence as the cause of the failure (8, 9).
