Within the broader agenda of adherence research, health beliefs have been identified as being significant predictors of adherence. Specifically, perceived threat as a health belief has received considerable attention in compliance and adherence research from multiple perspectives in multiple patient populations. The purpose of this paper is to analyze the concept of perceived threat as it relates to treatment adherence through a series of perspectives: conceptual, methodological, and empirical. Analysis of the literature reveals that there is lack of consistency in (...) operationalization of perceived threat as it relates to treatment adherence. Perceived threat is most commonly cited in studies that focus on health beliefs or utilize a stress and coping paradigm. Instruments have been developed with items that measure perceived threat. Measures of threat occur primarily through uni‐dimensional measures that do not reflect the inter‐relatedness of the threat experience to personal and contextual factors. Future research examining perceived threat from a cognitive appraisal perspective, where both primary and secondary appraisals can be examined, may provide additional insight into factors affecting treatment adherence. (shrink)

ABSTRACT Accurate self‐administration of antiretroviral medication therapy for HIV/aids is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on (...) behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/aids as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals’ medication‐taking behaviour, speaks to the inherent power inequities in the patient‐provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals’ situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidimensional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient‐centred interventions. (shrink)