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The purpose of this study is to evaluate existing research in the area of patient "compliance," to endorse reconceptualizing "compliance" in terms of "adherence," and to discuss the benefits of such a change for medical practitioners. This study critically reviews existing medical, nursing, and social scientific research in the area of patient "compliance." We assert that the literature reviewed is flawed in its focus on patient behavior as the source of "noncompliance," and neglects the roles that practitioners, the American medical system, and patient-practitioner interaction play in medical definitions of "compliance." The term "compliance" suggests a restricted medical-centered model of behavior, while the alternative "adherence" implies that patients have more autonomy in defining and following their medical treatments. We suggest that while the change in terminology is minor, it reflects an important paradigmatic shift for thinking about the delivery of health care. By enabling practitioners to more accurately identify patients' social and economic constraints and to provide them with more efficient educational and financial resources, this type of change will improve patient care. In general, by moving to a more social paradigm for understanding patient behavior, practitioners can expand the types of explanations, and therefore the types of solutions, they have for therapeutic adherence.

Relatively few studies have measured sexual functioning in women using a large, diverse, community-based sample with measures that allow for direct comparisons with previous findings. In this article, we: (1) describe prevalence of sexual activity in women by key sociodemographic characteristics, including age, race/ethnicity, marital status, and socioeconomic status; and (2) estimate the influence of key correlates on sexual problems. Data were analyzed from the Boston Area Community Health (BACH) Survey, a 2002-2005 community-based epidemiologic study of urologic and gynecologic symptoms, sociodemographics, health status, and psychosocial characteristics in a diverse sample of Boston area residents (N = 3,205 women aged 30-79 years). Analyses of sexual activity prevalence and reasons for inactivity were conducted on the full sample, while analyses of sexual problems and their correlates were conducted for the subset of women who engaged in sexual activity with a partner in the previous 4 weeks. A total of 49% of participants were not sexually active, citing lack of interest (51.5%) and lack of a partner (60.8%) as the most common reasons. Data pertaining to five dimensions of sexual functioning were gathered through a self-administered questionnaire adapted from the Female Sexual Function Index, measuring desire among all women and arousal, lubrication, orgasm, and pain among those who were sexually active. Among the sexually active, we obtained a 38.4% prevalence rate of sexual problems and 34.9% of those participants reported that they were also dissatisfied with their sex lives. Therefore, only 13.7% of the sexually active sample exhibited both sexual problems and dissatisfaction with their overall sex lives. Age was strongly and positively associated with sexual problems. In terms of psychosocial factors, depression, sexual and physical abuse in adulthood, global mental health functioning, and alcohol were associated with sexual problems, with variation across racial/ethnic groups.