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Life after a heart attack: Issues of method
Emma Hughes
School of Public Health, La Trobe University, Bundoora VIC
Abstract
'Noncompliance', and its more recent counterparts 'nonadherence' and 'concordance', are used in the medical literature to describe patients' failure to follow health advice (Haynes et al 1979). Since the 1960s medicine has had a keen interest in the problem of noncompliance. Not only does noncompliance mean that treatments will be less effective but also in the context of rising health care costs, it is seen as undermining the cost-effectiveness of clinical care. The same is true of health promotion/disease prevention programs. The extent to which noncompliance is a 'problem' is demonstrated by the over 30,000+ references in the medical literature alone.
Theoretical critiques of the medical and related health promotion literature have identified that noncompliance is most often researched, explained, and attempts made to 'solve' it on the basis of two assumptions (Trostle 1988; Hughes 1997; Donovan & Blake 1992; Lerner 1997). The first is the rationality of medical prescription and advice; the second consequent assumption is of patients' obligation to be equally rational in following medical prescription and advice, irrespective of the social context of their lives. Thus, noncompliance is viewed as primarily a problem of individual patients, explained in terms of irrational beliefs and behaviours that are barriers to compliance. Inherent in most research into noncompliance is a further assumption that 'scientific' evidence overrides all other kinds of evidence.
Such assumptions are extremely provocative for sociologists and unpacking 'noncompliance' is a compelling project. There is, to begin with, a sense of redressing injustice. Noncompliance stands out as a term that is used to categorise behaviours and people in a negative way. In addition, there is the sense that it is an issue inadequately researched as the assumptions about noncompliance confine research to a narrow focus and an equally narrow set of quantitative research methods.
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