Assessing Readiness for Adherence to Treatment

T o date, existing interventions designed to improve adherence have had limited success. According to a recent review of random-ized clinical trials of adherence interventions (McDonald, Garg, & Haynes, 2002), theoretical, multifaceted interventions in clinic settings are common. Based on a review of 33 trials, including 39 interventions, less than half (19) were associated with statistically significant improvements in adherence. The most effective interventions were multi-faceted, combining several of the following common strategies: increased patient education and counseling, convenience of care, and patient involvement in care; use of reminders; and rewards or reinforcements for adherence (McDonald et al., 2002). Although these complex interventions may produce greater success in many cases, there are several limitations. Such interventions are not typically based on an empirically supported theoretical model, and thus combine various strategies in a " hit or miss " fashion. This makes it difficult to determine which strategies were most effective with which patients. Moreover , interventions that adopt a one-size-fits-all approach are not tailored to an individual's unique needs (Miller, 1997) and assume readiness to be adherent. Finally, using a wide variety of strategies with all patients is expensive and impractical to deliver. The transtheoretical model (TTM) has been suggested as an approach to overcome these limitations by delivering individualized, theoretically delivered interventions for entire populations of