Accountability: a missing construct in models of adherence behavior and in clinical practice

Area of Science:

• Health behavior
• Social psychology
• Medical adherence

Background:

• Accountability is crucial for adherence to treatment plans, yet it's underutilized in healthcare.
• Current adherence models lack the concept of accountability, a key driver of patient motivation.

Purpose of the Study:

• To define accountability within the context of patient adherence.
• To integrate accountability into an existing adherence model framework.

Main Methods:

• Literature review of existing adherence models by a panel of experts.
• Incorporation of an accountability construct into a modified Social Cognitive Theory framework.
• Conceptualization of accountability on a spectrum from controlled to autonomous.

Main Results:

• Accountability significantly influences patient motivation and adherence to prescribed treatments.
• A spectrum of accountability, from controlled to autonomous, impacts adherence differently.
• Autonomous accountability, driven by internal desire, is hypothesized to enhance long-term adherence.

Conclusions:

• Defining and integrating accountability into adherence models is essential.
• This framework facilitates the development of accountability measures.
• Future interventions can leverage accountability to improve patient adherence and health outcomes.