COMPLIANCE WITH CARDIOVASCULAR-DISEASE PREVENTION STRATEGIES - A REVIEW OF THE RESEARCH

The efficacy of cardiovascular risk-reduction programs has been establ ished. However the extent to,which risk-reduction interventions are ef fective may depend on adherence. Noncompliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring ea rly or late in the treatment course, are clinically significant, as ad herence is one mediator of the clinical outcome. This article, which i s based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduc tion: pharmacological therapy, exercise, nutrition, and smoking cessat ion. The criteria for inclusion of a study in this review were: (a) fo cus on cardiovascular disease risk reduction; (b) report of a quantita tive measure of compliance behavior; and (c) use of a randomized contr olled design. Forty-sis studies meeting these criteria were identified A variety of self-report, objective, and electronic measurements meth ods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrate d to be successful in improving compliance included behavioral skill t raining, self-monitoring, telephone/mail contact self-efficacy enhance ment, and external cognitive aids. A series of tables summarize the in tervention strategies, compliance measures, and findings, as well as t he interventions demonstrated to be successful. This review reflects t he progress made over two decades in compliance measurement and resear ch and further; advances made in the application of behavioral strateg ies to the promotion of cardiovascular risk reduction.