CHAPTER 65: Noncompliance

Demographic and socioeconomic factors

• Low socioeconomic status

• Family instability, family disequilibrium

• Lack of peer groups/social isolation

• Extreme anxiety and overprotection of the child by parents

• Lack of social support from parents

• Lack of family cohesion

• Little parental supervision

• Poor communication between parents and patient

• Single-parent families

• Cost of medication

Patient-related factors

• Poor knowledge regarding medications

• Poor understanding of disease

• Low self-esteem/poor body image

• Forgetfulness

• Striving toward independence

• Social adjustment problems/poor social skills

• Poor coping mechanism/denial

• History of child abuse

• Dropout from school, risk-taking behavior

• Anger

• Posttraumatic stress disorder

• Psychological distress/depression

• Previous nonadherence

• intellectual disability

• Busy lifestyle/hectic daily schemes

Condition-related factors

• Duration of illness

• Substance abuse (e.g., alcohol)

• Perception of vulnerability: lack of symptoms and feeling of good health

• Longer time after transplant

Treatment-related factors

• Cost of medication

• Cosmetic side effects

• Total number of medications

• Number of medication doses per day

• Complexity and chronicity of medication regimen

• Taste of medication, pill size

Health care setting and health care provider–related factors

• Poor communication among health care provider, patient, and parents

• Authoritarian communication style of health care provider

• Poor didactic skills of health care provider

• Poor knowledge of health care provider of medication nonadherence

• Interference of follow-up with school/work

• Anger/lack of trust of family toward health care providers

• Lack of continuity of follow-up

• Single-provider health care system (unidisciplinary care)

• Increased waiting time to see provider/problems with accessibility of care