Is the Influence of Social Desirability on Patients' Self-Reported Adherence Overrated?

Adherence is critical to the success of HIV antiretroviral therapy, as clinicians need to be able to assess a patients adherence accurately so as to inform optimal treatment decision making. Electronic monitoring is considered by many to be the current state-of the art method of evaluating adherence; yet, this technology is limited by its high cost and the restrictions it places on common adherence strategies. Self-report measures are much more practical because of their relatively low cost and ease of administration; however, self-reported rates of antiretroviral adherence average 10% to 20% greater than rates derived from electronic monitoring, and their ability to explain virologic outcomes is inferior to electronic monitoring, resulting in the consensus that self-reports overestimate adherence. The reasons why patients often overestimate their adherence are poorly understood, and there are scarce data on the factors associated with self-report accuracy. Assuming that social desirability influences self-reports, the authors hypothesized that minimizing social desirability would enhance patients accuracy of selfreported adherence. To test this hypothesis, they conducted a pilot study involving a 2-week observation of adherence among persons on HIV antiretroviral therapy. Findings do suggest that social desirability may not be as significant a factor as suspected. It is possible that the imperfections of human memory may be responsible for a significant proportion of inaccurate reports of medication adherence. There needs to be further research on the reasons behind inaccurate self-reported adherence.