Improving compliance with medical regimens: case study with juvenile rheumatoid arthritis

There is ample literature to suggest that a high percentage of pediatric patients with chronic diseases fail to comply adequately with their medical regimens. This study examined the effectiveness of a token reinforcement program in improving the compliance of a 7-year-old girl with juvenile rheumatoid arthritis. The parents were taught to manage the program in the home. The patient earned tokens for complying with her treatment regimen and lost tokens when she failed to comply. Tokens were exchanged for routine and special privileges. Compliance with medications, splint wearing, and lying prone was assessed by observation. Baseline data showed low levels of compliance, particularly with splint wearing and prone lying. Introduction of the token reinforcement program resulted in immediate improvement in compliance; improvement was maintained during 10 weeks of follow-up.