Pediatric Adherence as a Multidimensional and Dynamic Construct, Involving a Triadic Partnership

OBJECTIVE: The aim of this paper is to integrate and draw attention to research findings that support our conceptualization of adherence as being multidimensional, dynamic, and involving a triadic partnership. METHODS: A review of relevant articles found in Medline, PsychLit, and reference lists provided in pertinent articles was performed. RESULTS: Significant progress has been made in identifying disease-related and psychosocial correlates of pediatric adherence and in developing intervention programs to promote adherence. Both lines of work have proceeded without a unifying framework for conceptualizing and measuring pediatric adherence. We offer a model that views adherence as comprising three defining aspects: (a) multidimensional, in support of the complexity and interrelatedness of treatment components, (b) a triadic partnership, as in mutually influential exchanges within and among the caregiver-medical team, child-medical team, and caregiver-child relationships, and (c) dynamic in relation to the notion of changes in developmental adaptive capacity, contextual characteristics, and disease course. CONCLUSIONS: Much work has yet to be done to validate, refine, and extend our model of adherence. Recommendations are offered for assessing each defining aspect, and a group-based methodology that accommodates longitudinal, prospective data is described.