Objectives: This paper will discuss 1) the hypothesized interrelationships between treatment, adherence and outcome in clinical research; and 2) factors impacting the adherence-outcome relationship.
Design: A systematic review of the results of studies presented in this symposium and in the chronic disorder/illness clinical research literature.
Population, Sample, Setting: Clinical research studies in the chronic disorder populations were the relationship between adherence and clinical outcome are reported, where pharmacological, educational or behavioral interventions have been employed.
Concept or Variables Studied Together: Treatment, adherence, and clinical outcome.
Methods: Review of the clinical literature.
Findings: The relationships among treatment, adherence and clinical outcome are complex and depend on the quality of measurement for adherence and outcome. Adherence is thought to be a mediator of the treatment-outcome relationship. However, the extent of the mediation may be limited, being partial rather full. Treatments for chronic disorders are typically multifaceted with varying levels of adherence across multiple treatments; hence good clinical outcomes may be observed yet adherence to the particular treatment of interest may be poor. Factors external to adherence-outcome relationship may be acting on both adherence and the clinical outcome, further complicating the relationship. The form of the direct relationship
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