Psychological Reactance as a Factor in Patient Noncompliance With Medication Taking: A Field Experiment¹

Abstract

Patient noncompliance with medical recommendations is widespread. The theory of psychological reactance sheds light on the subject. Reactance theory posits that when an individual discems a threat to a valued freedom, a motivational state compels the individual to reassert that freedom. The present study sought evidence of reactance in the compliance behaviors of 101 patients. Participants were exposed to either an authoritative‐oriented or a partnership‐oriented advice‐giving tone, coupled with either an opportumity for the participant to select certain features of the regimen or no opportunity to do so. While neither manipulation produced the anticipated causal results, both quantitative and qualitative correlational data clearly revealed a connection between reactance and noncompliance. The investigators report findings and make suggestions for further research.

Disease Management and Medication Compliance

“…Patient selfreports can be subject to patient recall issues and have been found to be significantly biased in favor of unrealistically high rates of compliance. 10,15 Provider estimates of patient behavior similarly overestimate compliance, 16,17 and reviews of pharmacy claims and dispensing records can be ''notoriously inaccurate.'' 18…”

“…Even in the presence of severe disease symptoms, medication side effects, uncomfortable administration, length of treatment, unpleasant or inconvenient frequency of dosage, and complex medication regimens are all associated with decreased medication compliance. 10,12 Second, patient-specific issues also play a role. To illustrate, a patient's health literacy is critical because patients cannot take their medications correctly if they cannot read instructions or properly interpret the label.…”

“…2,8,9 Noncompliance is pervasive, and high rates have been reported across all socioeconomic and age groups and in multiple health care settings. 10 Compliance tends to be more of a problem for the chronically ill who are on (multiple) medications for extended periods of time. In a widely cited study, a dramatic drop-off in compliance was observed 6 months after the initiation of drug therapy, with 50% of patients discontinuing regular intake of maintenance medications for chronic conditions, such as cholesterol-lowering drugs for hyperlipidemia.…”

The Exercise of Power in Communication

“…More recently, Fogarty and Youngs (2000) found that patients who were exposed to a partnership-oriented advice-giving tone by their physician, as opposed to an authoritative-oriented tone, were more likely to comply and less likely to experience reactance to their physician's requests. Similarly, research has found that when adolescents are told they cannot smoke, they are less likely to comply and more likely to engage in smoking as a means of restoration (Grandpre et al 2003).…”

Phénoménologie de la non-observance dans les maladies chroniques

“…Ce phénomène psychologique a été décrit sous le nom de réactance [8], et on a proposé que la réactance puisse être une cause de non-observance [24]. Ainsi, une étude a montré que l'observance était moins bonne lorsque les prescriptions médicales étaient faites de manière autoritaire, ne laissant pas de choix au patient [25].…”