Chapter 7 124 Introduction To not only predict adherence, but also to better understand the relationship between determinants and adherence, this supplement was written. When there is a better understanding about the predictors of adherence, it can be determined, from a psychological perspective, what potential interventions might be used to improve adherence. This supplement describes the causal mechanism of adherence to complement the prediction model of adherence described in Chapter 6, and describes some potential interventions, based on the predictors found, to improve adherence. Background Developments in health and social psychology have contributed to several models for explaining variations in health-related behaviors, which can be applied to exercise adherence. One of the models used, and the state-of-the-art model to predict adherence behaviors in patients with a chronic disease, is the Theory of Planned Behavior (TPB) [1]. The TPB supposes that a person’s intention to perform a behavior is the major determinant of that behavior [2]. Furthermore, a person’s intention is determined by three theoretically independent variables: a person’s attitude (indicated by a positive or negative evaluation of performing the behavior), subjective norm (the perceived social pressure that a person may feel to perform or not to perform the behavior), and perceived behavioral control (PBC) (the perceived ease or difficulty of performing the behavior). The TPB poses that people will intend to perform a behavior when they evaluate it positively, believe that important others think they should perform it, and perceive it to be under their control [2]. The TPB makes a useful contribution to understanding adherence in chronic illness, but focusing solely on the Theory of Planned Behavior may be insufficient to predict exercise adherence in patients with COPD. Adherence to prescribed exercise is influenced by an interaction of knowledge of, attitudes toward, and beliefs about health and exercise, perceived needs and abilities, outcome expectations (e.g. exercise history), biomedical and personality traits, feelings, lifestyle behaviors, and environments [3]. An extended TPB model may be more applicable in predicting adherence in people with a chronic disease [1]. In paramedical professions, it is widely accepted that the treatment regimen alone cannot fully account for patient outcome [4]. The relationship between patient and therapist (therapeutic alliance) has been viewed as an important determinant of treatment outcome and is considered central to the therapeutic process [5]. The construct of alliance in therapeutic situations refers to the sense of collaboration, warmth, and support between the patient and therapist [5]. In relation with the TPB it is shown that patients who experience a positive alliance are more likely to have a
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