Litt I F, Cuskey W R
Pediatr Clin North Am. 1980 Feb;27(1):3-15. doi: 10.1016/s0031-3955(16)33815-9.
In summary, compliance behavior among adolescents is complex and imcompletely understood. Although the study of compliance is important for understanding the adolescent's stage of psychological development, relationships with authority figures, and the beginning of the youngster's career as a consumer of health care, its ultimate importance lies in the prospect of improving the likelihood that medication will be utilized appropriately. The first step in the process involves systematic monitoring of compliance rather than doing so only when noncompliance is clinically suspected. When compliance is found to be problematic for an adolescent, resorting to "scare" techniques or re-education is rarely effective. A more positive outcome may be achieved by determining the circumstances under which the youngster was successful in complying and attempting to tailor-make the regimen accordingly. Barriers to compliance, such as the presence of side effects, previous negative experience with the medicine, and lack of conviction about the diagnosis of appropriateness of therapy, should always be explored. Other potential intervention strategies for improving compliance have been discussed. In the final analysis, however, as Jonson has noted, all strategies aimed at improving compliance must provide the patient with insight into his own situation and himself, as well as his capability of doing something other than conforming when he judges it best.
总之，青少年的依从行为复杂且尚未被完全理解。尽管对依从性的研究对于理解青少年的心理发展阶段、与权威人物的关系以及青少年作为医疗保健消费者职业生涯的开端很重要，但其最终重要性在于提高药物合理使用可能性的前景。该过程的第一步涉及对依从性进行系统监测，而不是仅在临床怀疑不依从时才进行监测。当发现青少年的依从性存在问题时，采用“吓唬”手段或再教育很少有效。通过确定青少年成功依从的情况并据此尝试量身定制治疗方案，可能会取得更积极的结果。应始终探究依从性的障碍，如副作用的存在、以前对药物的负面体验以及对治疗诊断合理性缺乏信心。还讨论了其他改善依从性的潜在干预策略。然而，归根结底，正如琼森所指出的，所有旨在提高依从性的策略都必须让患者了解自己的情况和自身，以及当他认为最佳时做出其他行为而非顺从的能力。
