People who reported greater health consciousness also tended to report better treatment adherence, according to a model built from survey data in six countries. The study set out to explain adherence behaviour by integrating two clusters of constructs, rather than treating medication-taking as a single issue. The reported relationship was positive, but it varied across the model and across some subgroups.
Health consciousness was positively associated with medication compliance, treatment adherence behaviour, health behaviour and control. The standardized coefficients ranged from 0.030 to 0.157 for medication compliance, 0.070 to 0.167 for treatment adherence behaviour, 0.372 to 0.524 for health behaviour and 0.275 to 0.493 for control. A standardized beta puts associations on a common scale; it does not by itself show that one factor causes another.
The model also found a positive indirect association between health consciousness and treatment adherence behaviour, with standardized coefficients ranging from 0.154 to 0.247. That relationship ran through other measured parts of the model, but the overall figure concealed a more complicated pattern. The analysis included 12 intermediary pathways: four were consistently statistically significant, two were largely nonsignificant and the rest produced mixed results.
Several links pointed in the same direction
Several of the model's internal relationships pointed in the same direction. Medication compliance was positively associated with treatment adherence behaviour, with coefficients from 0.276 to 0.444. Treatment concerns were negatively associated with medication compliance, with coefficients from -0.065 to -0.449. Their association with treatment adherence behaviour itself was small and often not statistically significant, ranging from -0.006 to -0.081. Control had a strong positive association with acceptance, ranging from 0.642 to 0.746.
Overall, the model explained 31.8% of the variation in treatment adherence behaviour. Across the overall and subgroup models, the explained share ranged from 22.6% to 38.5%. The age-stratified models accounted for 31.9% among participants below 60 and 22.6% among those above 60, showing that the model did not perform identically across age groups.
What the survey measured
The evidence came from a quantitative online questionnaire administered between January and April 2024. It included adults aged at least 18 who had at least one chronic disease in the United States, Germany, France, Spain, Norway and the Netherlands, with only participants who had consented to future research included. The final sample contained 4,081 people: 746 from the United States, 611 from France, 598 from Germany, 618 from Spain, 917 from the Netherlands and 591 from Norway.
The analysis placed health consciousness and other treatment-related constructs in a model of treatment adherence. Researchers used regression and reported standardized beta coefficients, two-tailed p values and R-squared, the share of variation explained by the model. Results were treated as statistically significant when the two-tailed p value was below 0.05.
Association, not proof of cause
Because the evidence came from a questionnaire, the results describe associations and cannot establish that health consciousness causes better adherence. The same caution applies to the other links in the model, including the negative association between treatment concerns and medication compliance.
Most reported associations were stable and statistically significant across the overall and segmented models. The health-consciousness results had exceptions in some age, employment and country groups. Treatment concerns had a less stable relationship with adherence, as did control with subjective health experience in the previous month. The findings therefore describe a network of reported relationships, not evidence that changing any one factor would improve adherence.
Paper data and sources
Original title: Developing a Comprehensive Model for Explaining Treatment Adherence Behaviour: Evidence From the International Beamer Consortium
Authors: Lupiáñez‐Villanueva F, Broekharst D, Mertens E et al.
Journal/Repository: Public health challenges
Status: Peer-reviewed
First online: 2026-10-11
DOI: Not available
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