Patient compliance with health care provider advice is a subject of particular importance in developing countries, one that has not been sufficiently studied. This article begins by explaining why this type of research is important and describing the various methodologies used to examine patient compliance in developed nations--notably self-reporting by the patient, collateral reporting by friends or relatives, pill or bottle counting, review of the patient's clinic attendance, review of clinical outcomes, and use of biochemical tracers. The applicability of each of these methods to scenarios commonly found in developing countries is then considered, and the results of the limited compliance research performed in developing countries are described. In general, it is suggested that self-reporting, collateral reporting, and pill or bottle counting can be employed effectively in many Third World situations. The article also notes the importance of standardizing research procedures, provides logistic advice about applying various compliance research methods in Third World conditions, and points up the need to validate the accuracy of the methods used.
PIP: Research is needed on patient compliance with health care provider advice in developing countries because 1) the consumption of pharmaceuticals is on the rise in developing countries due to the expansion of health care services and successful marketing of drugs by multinational pharmaceutical companies, 2) pharmaceuticals consume a large share of developing countries' limited health care budgets, 3) patient compliance plays an important role in improving patient health and enabling health care systems to be effective, 4) poor medical outcomes resulting from noncompliance may prompt dissatisfaction with the health care delivery system and cause deterioration of the patient-physician relationship, and 5) lack of compliance with pharmaceutical regimens leads to the storage of leftover medicine in homes, thus increasing the risk of accidental poisoning and misuse of pharmaceuticals. The authors explain how self-reporting by the patient, collateral reporting by friends or relatives, pill or bottle counting, review of the patient's clinic attendance, review of clinical outcomes, and use of biochemical tracers are used in developed countries to assess patient compliance. The applicability of each of these methods to scenarios commonly found in developing countries is then considered and the results of the limited compliance research performed in developing countries described. It is generally suggested that self-reporting, collateral reporting, and pill or bottle counting can be used effectively in many Third World situations. The authors stress the importance of standardizing research procedures, provide logistic advice about applying various compliance research methods in the Third World, and note the need to validate the accuracy of the methods used.