• adherence;
  • compliance;
  • counseling;
  • causal attributions;
  • behavior change


Patients and healthcare practitioners (HCPs) each have theories about the causes of medication adherence problems. Traditional patient education focuses on correcting patients' inaccurate beliefs, but more recent models suggest working within patients' theories. Secondary data from a telehealth medication adherence program were analyzed to determine whether patients' or HCPs' causal theories better predicted adherence, and the effect of discrepancy between HCP and patient theories. Patients with osteoporosis (N = 402) or endometriosis (N = 2,015) received telephone counseling. Adherence levels and patients' and HCPs' causal attributions were recorded at each call. Hierarchical linear modeling showed associations between patients' attributions and current-session adherence, but HCP-patient attribution discrepancies predicted better subsequent adherence in three of six empirical tests performed. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:261–273, 2008