Influence of patients' representations and beliefs about diabetes and its treatment on their adherence to therapy

Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is a multi-factor phenomenon. Most recent research has focu sed on a patient-centred approach, on the representations that the patient has with respect to medicine, health and disease (with particular regard to the perceived self-efficiency in managing the disease, trust in convention al medicine, treatment, drugs, etc) and on the level of agreement between t he patient's representations and those of the health care provider. These r epresentations can potentially act as barriers/facilitators on patients' ad hesion to treatment; the best adherence can only be obtained if the real ne eds of the patient are met, matching therapy with his/her representations a nd expectations, and acknowledging the constraints that everyday life puts on the individual. The indication is therefore to avoid exclusively conside ring the physical burdens of the disease, while ignoring the personal and s ocial significance of the experience that the patient is having. It will ta ke time for this to become routine in health care, since it requires a comp lex change from a traditional, bio-medical approach to an integrated bio-ps ycho-social approach. The aim of this review is to show how those disease r epresentations of diabetes, and the treatment having considerable impact on patients' adhesion, are being considered in recent literature, and how thi s nonetheless still constitutes a little explored aspect in medical consult ation and research.(C) 2001, Editrice Kurtis.