Perceived Health Control: A Promising Step Forward in Our Understanding of Treatment Adherence in Psychiatric Care

Objective: To examine the role of perceived health control variables in psychiatric patients’ adherence to prescribed treatment.

Methods: Cross-sectional study including 966 consecutive adult Spanish psychiatric outpatients attended from October 2013 to April 2014 at community mental health services in the Canary Islands. Diagnoses were made using the ICD-10 criteria. Participants completed the 8-item self-report Morisky Medication Adherence Scale, Form C of the Multidimensional Health Locus of Control Scale, the General Self-Efficacy Scale, and the Hong Psychological Reactance Scale at their regular clinic visit. Sociodemographic and clinical variables were gathered. Logistic regression analyses were conducted to determine the predictive power of the variables studied.

Results: The present findings confirm that the control beliefs variables studied are related to psychiatric patients’ self-reported adherence and support the dual health control hypothesis. This hypothesis specifies that the balance between internal and external health control beliefs (ie, the extent to which individuals attribute their health to their own actions or to external agents such as doctors, significant other people, or chance) is related to adherence to prescribed treatment. Results from logistic regression analysis indicated that health control beliefs interact with psychological reactance, exerting their effects on patients’ adherence (12.8% of the variance explained and 64.2% of patients were correctly classified). It was found that low scores on both internal and external health control beliefs (P < .001) as well as low level of affective (P < .001) and cognitive (P < .001) psychological reactance best predicted self-reported adherence.

Conclusions: The knowledge of control constructs beliefs in psychiatric outpatients could allow the psychiatrist to predict noncompliance, monitor patient progression more closely, and individualize patient education in an effort to increase treatment adherence in patients who have difficulties adhering to treatment plans.