Gender, status, role, and adherence-- implications for social structure on patient adherence to medical recommendations

by Hiromi Ono

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Socioeconomic and demographic factors have been largely viewed as "control variables" in patient adherence research. As a result, there is not a full understanding of socioeconomic and demographic influences on adherence. This study presents a conceptual model of patient adherence based on existing socioeconomic and demographic theories and then evaluates the model by secondary analysis of data collected in the Medical Outcomes Study, a study of the effects of structure and process on outcomes of care for patients with chronic disease (hypertension, heart disease, diabetes and/or depression). This paper focuses on the impact of social structure on patient behavior. It studies the effect of gender, role and status on patient's adherence to two types of physician recommendations: taking medications and exercising. It applies socioeconomic and demographic theories that model roles and statuses, and examines how roles and statuses produce different patient adherence patterns. It analyzes the effects of occupational and family responsibilities, role functional status, social class, and doctor-patient relationships on patient adherence. The authors found that household and occupational responsibilities are related to better patient adherence. Patients act as if adherence and performance of occupational and household responsibilities are complementary. They also found that those with severe illnesses are more likely to adhere to physicians' recommendations. Female patients are less likely to adhere to the recommendations. There was neither a significant social class effect nor a significant doctor's gender effect.

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