What is Non-adherence? And who is non-adherent? Is it the child/family unable to succeed in the mutually defined goals at the last visit? Is it the diabetes healthcare team unrealistically expecting the goals to be met? I believe the term "non-adherence" should be applied when there is some impediment to the process toward success. Clearly, if the patient/family is trying hard to reach the aforementioned goals and puberty gets in the way with unpredictably high blood sugars, this is not non-adherence/non-compliance. However, if the teen is having difficulty testing blood sugars such that he is not checking at all, we have a problem that places him at great risk. His non-adherence is a clue that there is an underlying problem interfering with performance of necessary self-care tasks. We could say, "this is his body, his life, and that he can do whatever he likes." However, as pediatric healthcare providers, we must try help these young people to take care of themselves so that they may be self-empowered in the future as adults.
Non-compliance (or non-adherence) denotes negativity. I, myself, fall prey to this implication and struggle daily to remind myself that we must try to find the underlying reason for the non-adherence behavior and not be judgmental. And what is my culpability for non-adherence as a physician? I am "non-adherent" when I do not attend to the needs of the patient and family. Sometimes, these needs are not readily apparent and I must explore more fully, taking even more time. Sometimes, I fail to determine the "hidden agenda" or what is really going on, thus preventing my patients from reaching mutually defined goals.
In my view, what is most important is to keep trying to communicate and leave the doors open for further communication if everything is not clear at the end of the office visit. Treatment goals may be renegotiated between physician/diabetes team and patient/family and then tweaked once again. Failure to understand that process is paramount in defining mutually agreeable goals and expectations will unjustly lead to use of the word noncompliance.
