Can a teaching and learning perspective deepen understanding of the concept of compliance? A theoretical discussion.

Patients' noncompliance is regarded as a major problem in health care and efforts have been made to understand the mechanisms behind compliance and noncompliance. The concept of compliance has been analysed and criticized because of the limited way it defines the roles of patients and health professionals and for being supportive of the authority of health professionals. Attempts have been made to change the paternalistic meaning of the concept of compliance and alternative terms have been introduced. However, there is a lack of studies about the teaching and learning component of compliance. The aim of this theoretical article was to examine the meaning of the concept of compliance as is it used in health care, and relate it to a patient-centred, teaching and learning perspective. It is argued that instead of focusing on noncompliant patient behaviour, it would be more powerful to focus on the way the patients experience and understand and on how to create conditions for developing understanding, as this in turn might influence the behaviour or way of acting. It is suggested that the teaching part of compliance could be carried out by 'to follow and let oneself be followed', which means a teaching and learning situation where the health professional follows the patient, guided by patient experiences, and need for understanding. At the same time it means that following the patient's experiences creates possibilities for the health professional to reason and act in a way that the patient can follow. The concept of 'play' is used when putting 'to follow and let oneself be followed' into effect. To this end, the health professional needs to develop a considered pedagogical standpoint.