Mishandling the gift of life: Noncompliance in renal transplant patients

Two studies investigating renal transplant patients' compliance with their post-transplant medical regimen are presented. Compliance was operationalized as a multidimensional construct incorporating behaviors that represent adherence to the regimen. Study 1 examined the association of noncompliance with clinically significant outcomes and the medical and demographic predictors of noncompliance. Noncompliance was associated with rejection episodes, graft loss, and multiple transplants. The best predictors of noncompliance were medication side effects, age, education, and insurance coverage. Study 2 examined the psychosocial predictors of noncompliance. After age and side-effects complaints, self-efficacy and threat appraisal were the best predictors of compliance. The implications of these results for expectancy-value models of health behaviors (e.g., protection motivation theory; Rogers, 1983) and their ability to predict compliance in patients following long-term regimens are discussed.