Strategies to Predict, Measure, and Improve Psychosocial Treatment Adherence

Abstract

Nonadherence to psychosocial and behavioral treatment is a significant public health problem that presents a barrier to recovery and effective treatment. An estimated 20% to 70% of individuals who initiate psychosocial mental health services discontinue treatment prior to clinicians' recommendations. Empirically supported, evidence-based, stand-alone or adjunctive psychosocial interventions treat an increasingly wide range of mental health conditions. A core assumption of most, if not all, interventions is that clients will fully and actively engage in the treatment protocol. Adherence to psychosocial treatment has received much less scientific attention, however, than adherence to medical treatment. Drawing extensively from existing research, this comprehensive review conceptualizes several types of psychosocial and behavioral treatment adherence, examines predictors of adherence to psychosocial treatment, summarizes measures of adherence, and describes existing interventions to enhance psychosocial treatment adherence.

Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’

“…Attrition is common in eTherapies 29 72 73 with this now a focus for research in the digital health sector more generally. The problem of attrition may also be an issue in mental health interventions, 74 75 with drop-out from psychological therapies being associated with poorer outcome for service users. 76 …”

Lessons Learned From the Trial of a Cardiometabolic Health Nurse

“…An unanticipated benefit for the researchers, but identified by the CHN, was how the consumers valued the one‐on‐one attention to their physical health. Similar studies show that patient‐centered consultations lead to increased treatment adherence (Gearing, Townsend, Elkins, El‐Bassel, & Osterberg, ; Thompson & McCabe, ). This is critical for people with SMI as a myriad of factors such as antipsychotic‐induced weight gain and poor clinician–patient communication contribute to poor overall treatment adherence (McCloughen & Foster, ; Sajatovic et al., ; Thompson & McCabe, ).…”

Adherence to behavioural interventions in multiple sclerosis: Follow-up meeting report (AD@MS-2)

“…8–10 Despite these successes, psychosocial interventions generally show drop-out rates from 25% to 75% and lack long-term follow-up data. 4 Measuring adherence to these interventions is a complex endeavour. In addition to missing appointments outright, patients fail to actively engage during, between or after sessions.…”

“…Multimodal measurement of adherence may be especially important in behavioural interventions to obtain a detailed estimate of patient engagement. 4 Moreover, the effectiveness of behavioural interventions frequently depends upon the continued application of newly acquired skills. As such, adherence research is at the core of all behavioural interventions.…”