Perspectives on Adherence to Recommended Health Behavior among Low-Income Patients

Although patient nonadherence with health care recommendations is a known barrier to controlling health care costs and improving health outcomes, little is known about variables that affect adherence to recommended health behaviors among low-income patients. Four focus groups were conducted among a sample of low-income patients, to examine their perceptions of adherence with recommendations for appointment keeping, special diets, and medications. Continuity of care and patient fears emerged as common themes contributing to adherence. Continuity of care consisted of having a positive interpersonal relationship with a single primary physician, and a system of coordinated care among multiple specialty physicians. Fear of dying, not living well, getting worse, and feeling bad again were strong promoters of adherence. Among low-income patients and care delivery systems with capitated funding, efforts are needed to improve continuity of care and increase provider awareness of the fears that patients bring to a care encounter.