Categories of treatment adherence: pragmatist, denier and accepter
Adherence (following the treatment plan) often depends on attitude: pragmatists seek help only when the condition deteriorates (gets worse), deniers reject the diagnosis and accepters follow the plan.
Remember
A pragmatist accepts being ill but acts only when the condition worsens, a denier avoids treatment since taking it would mean accepting the condition, and an accepter follows the plan because they want a normal life.
Patients may fall into three main categories in how they respond to a treatment plan. Adherence depends on beliefs as well as knowledge, so it helps to know what a person believes about their illness.
A pragmatist accepts the condition but seeks help only on deterioration (the condition getting worse), once it becomes practically bothersome (troublesome). Using a preventer inhaler (usually an inhaled steroid, which reduces swelling in the airways and works when taken regularly, even when the person feels well) only during flare-ups (times when symptoms worsen) is a common reason for poor asthma control.
A denier does not believe they have the disease, so they avoid treatment, because following the plan would mean accepting the condition. A related group, the distancers, play down their symptoms as not serious and as not needing treatment.
An accepter accepts the condition and views adherence to the plan as vital to achieving a normal life. The accepter treats the illness as real and the treatment as purposeful, so medication is more likely to be taken regularly rather than only when symptoms are troublesome.
These labels describe a stated belief, not a permanent judgement about a person's character. Cost, side effects, practical barriers and competing demands can still interrupt adherence in someone who values treatment. A useful first step is to explore what the person believes: a denier needs help to accept the diagnosis, whereas a pragmatist needs the benefits of regular prevention explained in terms of daily life.
Key facts
- Pragmatist
- accepts the condition but seeks help only on deterioration (the condition getting worse), once it becomes practically bothersome (troublesome).
- Denier
- does not believe they have the disease, so avoids treatment, because following the plan would mean accepting the condition.
- Accepter
- accepts the condition and sees adherence to the plan as vital for achieving a normal life.
- Distancer
- plays the condition down, sees little need for medical care and is related to the denier.
- Preventer inhaler
- reduces swelling in the airways and works when taken regularly, even when symptoms are absent.
- First step when treatment is not being followed
- check the person's beliefs about the diagnosis before assuming forgetfulness or a lack of information.
Exam traps
- A person who accepts the diagnosis but seeks help only when symptoms worsen is not a denier, because a denier does not believe the diagnosis and avoids treatment.
- Rejecting the diagnosis and avoiding medication is not the pragmatist pattern, because a pragmatist accepts the diagnosis and engages with treatment when the condition becomes troublesome.
- Taking daily treatment as part of normal life does not fit the distancer pattern, which is one of playing down the condition and seeing treatment as optional.
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