Lois A. Maiman

SOCIOBEHAVIORAL DETERMINANTS OF COMPLIANCE WITH HEALTH AND MEDICAL CARE RECOMMENDATIONS

Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individual noncompliance with health and medical advice. While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patient, regimen, or illness which, unfortunately, are usually neither predictive nor alterable. This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance. The review suggests that certain health beliefs (especially personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence arc the most productive dimensions for present intervention and further exploration. Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior. Further research should, with standardized questionnaires and analysts techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance.

The Health Belief Model: Origins and Correlates in Psychological Theory*

The Health Belief Model relates psychological theories of decision making (which attempt to explain action in a choice situation) to an individual’s decision about alternative health behaviors. Rosenstock 1 has attributed the origins of that tradition of behavior motivation theory underlying the Health Belief Model to Lewinian 2 theory of goal setting in the level-of-aspiration situation (a special case of the latter’s general field theory). Lewin and associates hypothesized that behavior depends mainly upon two variables: (1) the value placed by an individual on a particular outcome and (2) the individual’s estimate of the likelihood that a given action will result in that outcome.

Selected Psychosocial Models and Correlates of Individual Health-Related Behaviors

RELATIVELY LOW LEVELS of public participation in screening, immunization, and other preventive health programs have been extensively documented,21 50 55, 91 as have the generally poor rates of individual compliance with prescribed medical therapies.42, 52, 81, 86 Over the past two decades, hundreds of research reports and review articles have been published reflecting the desire to both discover and better under-

Physician-patient partnership in managing chronic illness.

No abstract available.

Walk-out patients in the hospital emergency department

Four hundred twenty-six patients walked out of The Johns Hopkins Hospital Adult Emergency Department before being treated between April 1976 and March 1977. Of these, 179 were matched for sex, race, age, shift and presenting complaint with controls to identify the distinguishing characteristics of walk-out patients. Walk-out patients have recent onset of symptoms, report a great deal of pain and discomfort at the time of initial visit, and wait a relatively short period of time before walking out. They are, however, likely to report little continuing pain or discomfort one to two weeks after followup, although they believe that they still need care. Walk-out patients do not seem to be exposed to objectively worse treatment in the emergency departemnt but seem to have less subjective tolerance for waiting.

Psychological and sociological barriers to prenatal care

Abstract This review of psychosocial characteristics of women who delay prenatal care reveals that perceptions of barriers to care need to be considered by both designers of prenatal programs and by health care professionals.