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Elizabeth L. McQuaid, Commentary: Integrating Lessons from Evidence-based Assessment of Adherence into Clinical Practice, Journal of Pediatric Psychology, Volume 33, Issue 9, October 2008, Pages 937–938, https://doi.org/10.1093/jpepsy/jsm137
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In the past two decades, our appreciation of the complexity of disease management behavior has increased, and the methods now available to assess adherence behavior have advanced accordingly. Multiple methods are now implemented in research settings, including electronic monitoring devices, well-validated interviews, and procedures that allow real-time data collection of adherence behavior. Quittner and colleagues (Quittner, in press; Modi, Lemanek, Ieverse-Landis, & Rapoff, 2007) provide a comprehensive overview of the most current methods available to measure adherence behavior, and offer a compelling list of recommendations for future instrument development and research on adherence assessment. Reviewing the available methods not only provides us with a useful framework for approaching scientific inquiry in this area, but also naturally raises some larger issues in how health care professionals understand and use information regarding patients’ adherence to medical regimens.
One practical limitation of measuring adherence behavior with state of the art methods is that the strategies that yield the most comprehensive picture of disease management behavior are generally also the most expensive and time-consuming, and may additionally require sophisticated data management procedures. This introduces substantial barriers for implementing these approaches into routine clinical care, where adherence assessment may be needed the most. Our colleagues in their busy primary care practice settings and emergency departments could benefit from a simpler, more targeted approach. What they want may not be possible—we know that you cannot capture the complexity of adherence behavior, particularly to complicated regimens, by asking a few quick questions or by ordering a simple blood test. There is no easy solution for nonadherence, and there is no simple measurement method to capture adherence behavior.
