Compliance and Rebellion

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Given the shortage of information on why children and teenagers might not follow the rules of a study they have agreed to participate in, Childhood Obesity News is looking at reports on situations that are somewhat related.

Non-compliance can occur in any setting, and in different scenarios it shows up in different ways. Despite these various manifestations, the urge to rebel seems to all come from the same deep psychological wellsprings. This probably includes the tendency of some kids to “cheat” when enrolled in a voluntary program that is meant to help them.

Non-compliant behavior is so pervasive that it has been awarded its own set of initials, as seen in an article by Dr. Fred Kleinsinger:

NCB is likely one of the most common causes of treatment failure for chronic conditions, though this is not widely or consistently recognized.

If looked at through certain lenses, that could sound dangerously like victim-blaming. Those who address the issue are generally careful to note that non-compliance is often unintentional or inadvertent. Sometimes it is unavoidable.

Patients who are minors or disabled must depend on the good will of others to help them carry out doctors’ orders. Grownups without support systems are vulnerable too. Once home from being X-rayed and having a splint applied, a mother of two small children will not be lying around with her ankle elevated above her heart.

Whether the NCB is intentional, unavoidable, or whatever, it hurts patients and frustrates doctors. There seems to be a certain irreducible amount of apparently intransigent resistance, and medical professionals wonder why.

Worse yet, Jim Lane calls patients “notoriously non-compliant” by their very nature, and cites research showing that “No methodology accurately predicts which patients will and will not adhere to a treatment plan”:

Non-compliant behaviour by patients… is pervasive in normal clinical care and there’s plenty of research that confirms this.

He quotes a Food and Drug Administration study of people being treated for chronic medical conditions. According to that agency’s stats, somewhere between 14% and 21% of patients don’t fill their original prescriptions, and of those who do, 30% to 50% fail to follow the instructions on the bottle.

For the moment, we leave aside people who are subjects in formal medical testing. This is about patients afflicted with chronic conditions, and their everyday, ongoing care.

What causes poor medication compliance? Patients may not feel that the medication is helping, or may believe that it will interfere with their daily activities. It might be too difficult to open the container, or to swallow the pill. They might be afraid of potential side effects, or experience actual side effects. The instructions might be confusing, or the total number of meds they are expected to take might be confounding. Sometimes they just forget.

Your responses and feedback are welcome!

Source: “Working with the Noncompliant Patient,” NIH.gov, Spring 2010
Source: “Can Patient Engagement Improve Protocol Compliance?,” Longboat.com, 02/21/17
Source: “Patient & Protocol Compliance In Clinical Trials,” ClinicalLeader.com, 03/30/15
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Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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