1. Categories of Medical Non-Adherence Gerald P. Koocher, Ph.D., ABPP Identifying the basis for deviating from the prescribed course of treatment is the first step.

2. Type 1: Inadequate Knowledge Is information available to patient and family? Is the form of information comprehensible? Is the information appropriate to age and culture? Are the rationales for components of treatment clear?

3. Type 2: Psychosocial Resistance Explore social or cultural pressures. Assess environmental factors. Assess for psychological factors –Attributions –Motivations –Defense mechanisms –Psychopathology

4. Type 3: Educated Non-Adherence Does the patient have adequate reasoning capacity to consent? Can the patient articulate personal values or preferences? Have all reasonable alternatives been explored? Is the patient’s choice morally and legally defensible?

5. Inquiring about Non-Adherence What has your doctor asked you to do in order to best manage your illness (or to stay healthy)? What are the hardest pieces of medical advice to follow? Which parts do you skip or miss most often?

6. References Koocher, G. P., McGrath, M. L., & Gudas, L. J. (1990). Typologies of non-adherence in cystic fibrosis. Journal of Developmental and Behavioral Pediatrics, 11, 353 - 358.