Abstract
New approaches to understanding patient nonadherence to chronic disease medications
are urgently needed. To explore whether patient hidden motives and their underlying
assumptions contribute to nonadherence, we examined an innovative application to health
care of a transformative learning process successfully used in work settings, immunity-to-change. Eligible participants taking at least 2 chronic disease medications, filling prescriptions
at U.S. chain drugstores, wanting to continue to take medications and reporting adherence
problems underwent a psychological interview focused on their medication-taking behavior
as part of a market survey. Participants (n=46) were interviewed as a construction sample to create a preliminary set of motive
clusters. To test the completeness of the cluster categories, 17 additional eligible
persons were interviewed. An established psychological interviewing method was used
to identify hidden motives and unrecognized assumptions underlying non-adherent behavior.
Hidden motives (n=167) for nonadherence were identified and categorized into 6 clusters based on their
commonality (n, %): (1) to avoid interference with other priorities (40, 24%), (2)
to avoid losing control (35, 21%), (3) to avoid a negative identity (28, 17%), (4)
to be one’s own doctor (28, 16%), (5) to keep an arm’s length relationship to one’s
medications or to the medical establishment (27, 16%) and (6) to avoid unpleasantness
(10, 6%). Within each cluster, a set of previously unrecognized assumptions inhibiting
adherence was identified. in conclusion, hidden motives, and their underlying assumptions,
contributing to chronic disease medication nonadherence were identified using a transformative
learning process. Research is needed to test this approach in larger general population
samples.
Key Indexing Terms
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Article info
Footnotes
Supported by CVS/Caremark, Inc.
R. Kegan and L. L. Lahey are principals of a limited liability corporation, Minds at Work, LLC, which offers training programs for professional development. The other authors have no financial or other conflicts of interest to disclose.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the CVS/Caremark, Inc.
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© 2014 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
