Reconceptualizing medication adherence: Six phases of dynamic adherence

Robin E. Gearing, Lisa Townsend, Michael MacKenzie, Alice Charach

Research output: Contribution to journalReview article


Nonadherence is the Achilles' heel of effective psychiatric treatment. It affects the resolution of mental health symptoms and interferes with the assessment of treatment response. The meaning of the term adherence has evolved over time and is now associated with a variety of definitions and measurement methods. The result has been a poorly operationalized and nonstandardized term that is often interpreted differently by providers and patients. Drawing extensively from the literature, this article aims to (1) describe changes in the concept of adherence, drawing from the mental health treatment literature, (2) present a more comprehensive definition of adherence that recognizes the role of patient-provider transactions, (3) introduce dynamic adherence, a six-phase model, which incorporates the role of transactional processes and other factors that influence patients adherence decisions, and (4) provide recommendations for providers to improve adherence as well as their relationships with patients.

Original languageEnglish (US)
Pages (from-to)177-189
Number of pages13
JournalHarvard review of psychiatry
Issue number4
StatePublished - Jul 1 2011


  • Medication adherence
  • Mental illness
  • Patient-provider relationship
  • Treatment compliance

ASJC Scopus subject areas

  • Psychiatry and Mental health

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