Caregiver Adherence in Behavior Interventions: An Evaluation of Definition and Measurement

Adherence to interventions has received significant attention in scientific communities, including behavior analysis. This is likely due to the importance of adherence to promote long-lasting behavior change for clients in uncontrived settings and the costly impact of nonadherence. Unfortunately, caregiver adherence to behavioral interventions is poor, relative to other forms of intervention (e.g., medication). Despite widespread recognition of the importance of adherence, adherence has remained a passive concept devoid of technology. To advance the scientific study of adherence, a better understanding of the concept of adherence is needed. To this aim, we used a mixed-method approach to explore the stimuli behavior-analytic researcher-clinicians and clinicians commonly attributed to the concept of adherence in particular, as it pertains to caregiver adherence to behavioral interventions designed to reduce challenging behavior. In addition, we summarize measurement systems reported by professionals to measure adherence, as well as barriers to measuring adherence in clinical settings. We conclude by calling for action in four primary areas to advance our conceptualization and technology of caregiver adherence. These include a need for a concept analysis on adherence, reliable and valid methodologies to measure adherence, organizational contingencies that promote adherence, and professional teaching and training on adherence.