Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

Abstract

Within the context of poorer patient outcomes and rising healthcare costs, we need to better understand why many patients do not engage fully with their treatment plan. Movement away from talking about "compliance" towards "adherence" and "concordance" is evidence of a recognition that this is a two-way process. Whilst healthcare professionals expect patients to engage in treatment, equally, patients have expectations (whether positive or negative) of their treatment and their need for engagement. There is a need for an effective method that can specifically target those interventions that will provide the most benefit to individual patients and which, crucially, is easy and inexpensive to administer in everyday practice and widely applicable. Rubin's Four Tendencies model identifies a patient's "response to outer and inner expectations" as a key factor in adherence. The model therefore provides an opportunity to test such a targeted, patient-specific strategy and we present a call to action for research in this area.

Keywords: Compliance; Intervention; Medication; Rubin's Four Tendencies; Treatment adherence.

Fig. 1

Key contributing factors to treatment adherence [3, 5].

Fig. 2

Rubin's Four Tendencies.

Fig. 3

Hypothetical alignment of adherence interventions to Rubin's Four Tendencies. Testing of the effectiveness of this mapping strategy should be performed using well-designed randomised controlled trials.