Immunity-to-Change: Are Hidden Motives Underlying Patient Nonadherence to Chronic Disease Medications?

New approaches to understanding patient nonadherence to chronic disease medications are urgently needed. To explore whether patient hidden motives and their underlying assumptions contribute to nonadherence, we examined an innovative application to health care of a transformative learning process successfully used in work settings, immunity-to-change. Eligible participants taking at least 2 chronic disease medications, filling prescriptions at U.S. chain drugstores, wanting to continue to take medications and reporting adherence problems underwent a psychological interview focused on their medication-taking behavior as part of a market survey. Participants (n = 46) were interviewed as a construction sample to create a preliminary set of motive clusters. To test the completeness of the cluster categories, 17 additional eligible persons were interviewed. An established psychological interviewing method was used to identify hidden motives and unrecognized assumptions underlying non-adherent behavior. Hidden motives (n = 167) for nonadherence were identified and categorized into 6 clusters based on their commonality (n, %): (1) to avoid interference with other priorities (40, 24%), (2) to avoid losing control (35, 21%), (3) to avoid a negative identity (28, 17%), (4) to be one’s own doctor (28, 16%), (5) to keep an arm’s length relationship to one’s medications or to the medical establishment (27, 16%) and (6) to avoid unpleasantness (10, 6%). Within each cluster, a set of previously unrecognized assumptions inhibiting adherence was identified. in conclusion, hidden motives, and their underlying assumptions, contributing to chronic disease medication nonadherence were identified using a transformative learning process. Research is needed to test this approach in larger general population samples.