An Intentionalist Model of Patient Adherence

Abstract

If we understand patient adherence as to the performance of a therapeutic action , we can now propose an ‘intentionalist ’ model of adherence, establishing a certain hierarchy of mental states in which emotions play as vital a role as knowledge , beliefs , skills , etc. In this model, emotions play this role in inducing revisions of beliefs , expectations, and preferences of patients’ various desires . It is obvious that non-intentional factors (such as pain or pleasure) , can have a motivational role—indeed, sometimes overwhelmingly so. Events can intervene as a substratum of new beliefs, or by provoking the emergence of emotions. Exogenous factors, such as the presence or absence of resources can intervene in encouraging or limiting patient adherence. It is important to recognize that a fundamental gap exists between therapeutic actions and their results. For not only do actions not assure a desired result, they may only play a partial role if the desired result does happen. At best, our actions are only partly responsible for what happens to us. For example, a patient may increase her insulin dose to reduce her blood sugar after dinner. But it is misleading to say that her action was to ‘normalize her blood sugar’. This does not mean, of course, that by adjusting her insulin dose, the patient does not try to normalize her blood sugar (and that her doctor must not do everything in order to convince her to try to do it).