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Accountability: a missing construct in models of adherence behavior and in clinical practice

Authors Oussedik E, Foy CG, Masicampo EJ, Kammrath LK, Anderson RE, Feldman SR

Received 1 March 2017

Accepted for publication 31 May 2017

Published 25 July 2017 Volume 2017:11 Pages 1285—1294


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Elias Oussedik,1 Capri G Foy,2 E J Masicampo,3 Lara K Kammrath,3 Robert E Anderson,1 Steven R Feldman1,4,5

1Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 2Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA; 3Department of Psychology, Wake Forest University, Winston-Salem, NC, USA; 4Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 5Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

Abstract: Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients’ motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8–12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients’ autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura’s Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.

Keywords: autonomous accountability, controlled accountability, duress, health promotion, Self-Determination Theory, shame, Social Cognitive Theory, volition

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