How predictable could patient’s adherence to treatment be?

February 2017

Patients taking medications to manage their long-term conditions show different attitudes over time. We have demonstrated time and again that patient’s motivations to adhere to their treatment obey to their necessity beliefs and concerns regarding their medication and those beliefs drive their behaviours. The fact that these behavioural drivers exist means that behavioural changes following an intervention on a cohort leads to changes on the overall adherence. Obvious!… but is it predictable?



The Necessity beliefs and Concerns Framework (NCF™) has a two-dimensional spatial representation for mapping patient’s location into 4 quadrants each one representing one of 4-states [Sceptical (low Necessity beliefs, high Concerns), Ambivalent (high, high), Indifferent (low, low), Accepting (high, low)] based on their answers to the Beliefs about Medication Questionnaire (BMQ™). This is certainly not a static situation over time and it is at the core of SoS behavioural change methodology to create informed patients, so their choice guide their “movements” across the 4-states NCF™ map. Why? Because patients’ adherence to their treatment is strongly dependant on their psychological state… and there is obviously an ideal state [Accepting] where their necessity beliefs are high and have low concerns about their medication which leads to superior adherence levels, which improves their health. This does not mean that patients in the other 3 states are not adherent at all, but it is so much simpler to achieve the highest levels of adherence no matter the disease area when patients are in this Accepting state (for instance, 6 times more for patients with type 2 diabetes mellitus) that it worth all necessary efforts and costs from healthcare stakeholders.


Remember: no patient’s location in the 4-state NCF™ map is eternal, so the good thing is that we can design interventions to change patient’s behaviour to help them become more adherent, and the bad thing is that there are counteracting external forces that negatively impact on their motivations to “move”. Patients conscious and unconscious choices lead to “movement” across the 4-state NCF™ map. Understanding patients’ intrinsic and extrinsic motivations through the Perceptions and Practicalities Approach (PAPA™) is key to laying the pathway for change and proceeding with bespoke patients’ behavioural change programme is an integral part of any Patient Support Programme.


For those of you who think “the shortest distance between 2 points is the straight line” … Yep! This is not always evident, at least in the 4-state NCF™ map for those Sceptical patients who face a dilemma: can they both reverse their low Necessity beliefs and high Concerns at the same time? Possible but difficult. Transitions tend to occur sequentially so it is likely patients “move” from a Sceptical state to an intermediate state [Ambivalent, Indifferent] through behavioural change programmes rather than “jumping” directly towards the Accepting state.


And here is your food for thought: Which is the optimum pathway to acceptance, is it more difficult to first raise a patients’ low Necessity beliefs or lowering their high Concerns. And a related thought: Should you aim to first “move” those patients in an Indifferent state towards the Accepting state by heighten their Necessity beliefs or transforming Ambivalent patients into Accepting patients by lowering their Concerns. If these questions are bothering you, as you look to create optimally effective Patient Support Programme, then we look forward to hearing from you.