Abstract
Objective
To clarify the mechanisms of adherence.
Methods
A cross-sectional, multicenter French study using a self-questionnaire administered by 116 general practitioners to 782 obese type 2 diabetic patients.
Results
The analysis of 670 completed questionnaires revealed a strong association between the adherence to medication and the behavior of fastening the seatbelt when seated in the rear of a car. Multivariate analysis indicated that this behavior was an independent determinant of adherence to medication (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.4–3.6, P < 0.001) with the same OR as the motivation to adhere to medical prescriptions (OR 2.2, 95% CI 1.3–3.6, P = 0.003) in a model with good accuracy (area under the receiver operating characteristic curve 0.774). A multiple correspondence analysis suggested that adherence to medication and seatbelt behavior are “homologous” behaviors, with homology between phenomena defined by the fact that they share a common etiology.
Conclusion
Adherence may have two dimensions: passive (obedience, the main determinant of seatbelt behavior) and active (motivation). This conclusion has theoretical and practical implications. Firstly, empowerment through patient education can be defined as a process that replaces the passive mechanism of adherence in patients’ minds with an active, conscious choice. Secondly, recognizing these two dimensions may help to establish a tailored patient-physician relationship to prevent nonadherence.
Acknowledgments
This study was sponsored by Sanofi-Aventis. The author is grateful to the physicians who participated in the study, to Marmar Kabir Ahmadi and Christian Kempf who performed the statistical analysis, and to Professor Sadek Beloucif for fruitful discussions.
Disclosure
The author reports no conflicts of interest in this work.