Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK.
Psychol Health. 2023 Jun;38(6):726-765. doi: 10.1080/08870446.2022.2144923. Epub 2022 Nov 29.
Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of and Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the to adhere as well as or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.
药物治疗不依从是一个全球性问题，会影响个人和社会的健康和经济结果。本文概述了如何定义和测量依从性，考察了不依从的影响、普遍性和决定因素。还讨论了如何从社会心理角度了解干预措施的发展，以优化依从性，并提出了一系列建议，以克服与药物治疗不依从性文献相关的常见局限性。
不依从最好理解为个体与特定疾病/治疗之间的相互作用，处于社会和环境背景中。依从性是动机和能力的产物，其中动机包括有意识的决策过程，但也包括更“本能”、直觉和习惯性的过程。能力包括遵守医嘱所需的身体和心理技能。动机和能力都受到环境和社会因素的影响，这些因素影响着遵守医嘱的意愿以及行动的提示或线索，这些提示或线索可能是内部的（例如出现症状），也可能是外部的（例如收到提醒）。对依从性干预措施的系统评价表明，有效的解决方案难以捉摸，部分原因是很少有具有坚实理论基础的解决方案。如果针对个体的依从性支持措施能够针对影响个人遵守医嘱的动机和能力的具体看法（例如对疾病和治疗的看法）和实际情况（例如能力和资源）进行定制，那么这种支持措施将更加有效。
