University of Michigan, School of Public Health, Ann Arbor, MI, USA.
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Gen Intern Med. 2018 Feb;33(2):207-215. doi: 10.1007/s11606-017-4197-5.
Achieving and sustaining high levels of adherence to medication regimens is essential to improving health outcomes, but continues to be a challenge for a sizable proportion of patients. Decades of research suggests that medication adherence is determined by a complex constellation of factors. Social-behavioral science research has focused on creating frameworks that identify which contextual, personal, social, or drug-related factors appear to most influence adherence. Comprehensive models of adherence propose specific structural relationships between these factors that can be used to plan for, implement, and monitor programs that seek to optimize adherence. The use of social-behavioral models offers multiple advantages in both practice and research environments; however, the breadth and depth of these models can deter many from engaging in this important exercise. To promote the use of social-behavioral frameworks and models of adherence, we provide a brief overview of the advantages in using a social-behavioral lens in adherence work, a sampling of models used in HIV medication adherence research that have high generalizability to other conditions, and practical guidance for grounding adherence promotion strategies in evidence informed by social-behavioral science research.
实现并维持高水平的药物治疗依从性对于改善健康结果至关重要,但对于相当一部分患者来说,这仍然是一个挑战。几十年来的研究表明,药物依从性取决于一系列复杂的因素。社会行为科学研究的重点是创建框架,以确定哪些环境、个人、社会或与药物相关的因素似乎对依从性影响最大。依从性的综合模型提出了这些因素之间的特定结构关系,可用于规划、实施和监测旨在优化依从性的项目。在实践和研究环境中,使用社会行为模型具有多种优势;然而,这些模型的广度和深度可能会使许多人望而却步,无法参与这项重要的工作。为了促进社会行为框架和依从性模型的使用,我们简要概述了在依从性工作中使用社会行为视角的优势、在 HIV 药物依从性研究中使用的一些具有高度普遍性的模型,以及将依从性促进策略建立在社会行为科学研究证据基础上的实用指导。