Identifying and Predicting Profiles of Medical Noncompliance: Pediatric Caregivers’ Antibiotic Stewardship

Abstract

Sometimes compliance with medical recommendations is problematic. We investigated pediatric caregivers’ (N = 606) patterns of noncompliance with antibiotic stewardship based on the obstacle hypothesis. We tested predictors of noncompliance framed by the obstacle hypothesis, dissonance theory, and psychological reactance. The results revealed four profiles of caregivers’ stewardship: one marked by compliance (Stewards) and three marked by types of noncompliance (Stockers, Persuaders, and Dissenters). The covariate analysis showed that, although psychological reactance predicted being noncompliant, it was types of obstacles and discrepant experiences that predicted caregivers’ patterns of noncompliance with antibiotic stewardship. Campaign planning often focuses on identifying the belief most associated with the targeted outcome, such as compliance. Noncompliance research, however, points out that persuaders may be successful to the extent to which they anticipate obstacles to compliance and address them in their influence attempts. A shift from medical noncompliance to patient engagement also affords an opportunity to consider how some recommendations create obstacles for others and to find positive ways to embrace conflicting needs, tensions, and reasons for refusal in order to promote collective goals.

Acknowledgments

We wish to thank Erina MacGeorge, Xun Zhu, and Amanda Applegate for their feedback on an earlier version of this paper.

Additional information

Funding

This work was supported by CDC’s investments to combat antibiotic resistance under award number 200-2016-91939, and by CDC’s Get Smart: Know When Antibiotics Work through a cooperative agreement: CDC-RFACK14-1401PPHF14.The content is solely the responsibility of the authors and does not necessarily represent the views of the funding agencies.