The Health Compliance Model-II.

Abstract

The Health Compliance Model-II (HCM-II) is posited to address the multivariate, dynamic, and idiosyncratic nature of predicting adherence to health behaviors. The HCM-II advances upon the original Model (E.M. Heiby & J.C. Carlson, 1986) by emphasizing emotional causal variables indicated by a psychological behaviorism framework (A.W. Staats, 1996). The HCM-II also adds causal variables from the empirical support of eclectic cognitive-behavioral models: Social Cognitive Theory (A. Bandura, 1991); Modified Social Learning Theory (K.A. Wallston, 1992); Health Belief Model (I.M. Rosenstock, 1991); and Theories of Reasoned Action/ Planned Behavior (M. Fishbein & I. Ajzen, 1975). Preliminary development of an assessment instrument derived from the proposed HCM-II is described and implications for treatment and prevention of noncompliance are discussed. Keywords: health compliance model-ii, psychological behaviorism, adherence, health behaviors. ********** Noncompliance or nonadherence to common healthy life-style recommendations has been subject to intense scrutiny by the behavioral health research community in recent years. Now that medical advances of the 20th century have brought many formerly fatal, acute illnesses under control (Myers & Midence, 1998), public health attentions focus more closely upon the promotion of self-controlled prevention and treatment of chronic medical conditions. However, after more than 30 years of research and intervention, poor compliance statistics with mainstream health behavior recommendations is cause for national concern (Conner & Norman, 1996). This predicament is reflective of shortcomings within popular theoretical models used to explain and predict compliance to heath behaviors. Despite a large empirical literature, there is still no consensus as to the superiority of any theory or model, or even that particular variables are more useful than others for understanding the determinants of compliance within discrete behavioral health domains (Weinstein, 1993). One exception is an operant behavioral analysis that for decades has been shown to effectively guide treatment in environments where discriminative stimuli and contingent reinforcement can be controlled (e.g., daCosta, Rapoff, Lemanek, & Goldstein, 1997; Haynes, Sackett, Gobson, Taylor, Hackett, Roberts, & Johnson, 1976). Given that environmental engineering is usually not feasible, most compliance enhancement theories focus on an eclectic variety of cognitive-behavioral health compliance competency variables. We describe the Health Compliance Model-II (Frank, 2000; Heiby & Frank, 2003; Heiby & Lukens, in press) as an attempt to move toward a unification and expansion of the operant behavioral and cognitive-behavioral theoretical and empirical compliance enhancement literatures. [FIGURE 1 OMITTED] There are several reviews of cognitive-behavioral compliance theories (e.g., Horne & Weinman, 1998; Myers & Midence, 1998; Norman & Conner, 1996; Weinstein, 1993). In Figure 1, we summarize the variables proposed in these theories that enjoy substantial empirical support, so not all posited variables in each theory are listed. The transtheoretical or stages of change theories have not been included in Figure 1 because they describe the options of change rather than the posit conditions and skills involved in acquiring behavioral health regimens (e.g., as suggested by DiClemente, 1993, p. 105). The theories are presented in approximate chronological order from right to left. While the number of empirically supported variables included in theories increase over time, it is apparent that no theory has fully integrated the contributions of prior theories. Weinstein (1993) argued that a more comprehensive theory of compliance is needed, and issued the following appeal to the research community for ongoing model development: Because these theories contain at least a grain of truth, empirical tests typically yield some degree of confirmation, enough to keep the theory under scrutiny from being rejected . …