6 Patients and Healthcare

Adherence as a collaborative process

Patients actively participate in healthcare by seeking care, describing symptoms, weighing options, following treatment plans, and returning for follow-up. Their actions are shaped by personal beliefs and circumstances as well as by the care they receive. Understanding these influences can help clinicians make care safer, more effective, and better aligned with each patient’s needs.

Treatment adherence is the extent to which a person’s actions—such as taking medication, following a care plan, or attending appointments—correspond with a plan agreed upon with a healthcare professional. The term emphasizes collaboration, unlike compliance, which can suggest that patients are expected simply to obey instructions. Adherence is not a fixed personal trait or solely a matter of willpower.

Factors that affect adherence

Adherence is shaped by five interacting dimensions: patient-related factors, condition-related factors, therapy-related factors, social and economic factors, and healthcare-team and system factors. Barriers can include a complicated medication schedule, cost, side effects, forgetfulness, depression, or difficulty reaching a clinic. A patient may also decide not to start or continue a treatment when its perceived risks or burdens outweigh its expected benefits.

Clinicians should ask about barriers without blame and work with patients to find feasible solutions. Better communication is associated with better adherence, but communication alone cannot remove practical barriers or guarantee that a treatment will be followed.

Communication and shared decisions

Clear, respectful communication helps patients understand their health and take part in decisions. Useful practices include listening without interruption, asking open-ended questions, explaining unfamiliar terms in plain language, and inviting questions.

Teach-back checks whether an explanation was clear: the clinician asks the patient to describe, in their own words, what they will do next. It assesses the explanation rather than testing the patient. It is an evidence-based approach that supports engagement, safety, and adherence.

Shared decision-making combines clinical evidence and professional expertise with a patient’s preferences, priorities, and circumstances. The clinician explains reasonable options and their likely benefits and harms, the patient describes what matters to them, and they choose a plan together. For example, a patient choosing among treatments may weigh symptom relief against side effects, cost, or effects on daily routines.

Beliefs, emotions, and healthcare choices

Patients interpret illness and treatment through their own experiences and expectations. Beliefs about what caused an illness, how serious it is, whether it can be controlled, and how long it may last can affect whether a person seeks care or considers treatment worthwhile. For example, a person with high blood pressure may feel well and conclude that medication is unnecessary; concerns about side effects may reinforce that view. Asking what the patient understands and worries about can reveal reasons behind a decision and open discussion of benefits, risks, and alternatives.

Fear, stress, sadness, or feeling overwhelmed can make it harder to ask questions, process information, remember instructions, or plan daily care. Confidence in one’s ability to manage treatment (self-efficacy), trust in clinicians, prior healthcare experiences, cultural beliefs, and support from family or friends can also influence choices. These factors differ among individuals, and no single psychological trait reliably explains a patient’s behavior. Evidence on illness beliefs and adherence is mixed, so clinicians should explore each person’s perspective rather than assume what motivates them.

Applying a patient-centered approach

A practical conversation can explore what the patient believes is happening, what they hope treatment will achieve, and what might make the plan difficult. The clinician and patient can then adapt the plan, clarify misunderstandings, and arrange follow-up. This approach respects patient autonomy while addressing psychological and practical influences on care.

Patient behavior reflects the interaction of personal beliefs and emotions, treatment demands, social and economic conditions, and healthcare systems. Treating adherence as a collaborative process—not a test of obedience—supports informed choices and realistic care plans.