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From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions


  • Bissell, Paul
  • May, Carl R.
  • Noyce, Peter R.


As a framework for organising health care interactions, compliance and adherence have come in for increasing criticism in recent years. It has been suggested that interactions with patients should not be viewed simply as opportunities to reinforce instructions around treatment: rather, they should be seen as a space where the expertise of patients and health professionals can be pooled to arrive at mutually agreed goals. This concept--known as concordance--is attracting increasing interest in health services research within the UK. In this paper, we seek to empirically explore the relevance of a re-framed consultation through qualitative interviews with a small group of English speaking patients of Pakistani origin with a diagnosis of type 2 diabetes. We suggest that the focus of many respondents in this study on material and structural factors limiting diabetic regimen integration and the emphasis on a 'doctor-centred' model of health care interactions represent distinct problems for the accomplishment of the concordance project. However, given that some patients sought greater understanding and appreciation by health professionals of the subjective aspects of living with diabetes, if it is evaluated at the level of health care relationships, rather than health outcomes (such as improved compliance) concordance may well be a significant development for those who suggest that respect for the patients agenda is a fundamental aspect of health care.

Suggested Citation

  • Bissell, Paul & May, Carl R. & Noyce, Peter R., 2004. "From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions," Social Science & Medicine, Elsevier, vol. 58(4), pages 851-862, February.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:4:p:851-862

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    Cited by:

    1. Johnston, Meghan E. & Herzig, Rebecca M., 2006. "The interpretation of "culture": Diverging perspectives on medical provision in rural Montana," Social Science & Medicine, Elsevier, vol. 63(9), pages 2500-2511, November.
    2. Williams, Kevin Frank, 2007. "Re-examining 'professionalism' in pharmacy: A South African perspective," Social Science & Medicine, Elsevier, vol. 64(6), pages 1285-1296, March.
    3. Lucas, Henry, 2015. "New technology and illness self-management: Potential relevance for resource-poor populations in Asia," Social Science & Medicine, Elsevier, vol. 145(C), pages 145-153.
    4. Lemire, Marc & Sicotte, Claude & Paré, Guy, 2008. "Internet use and the logics of personal empowerment in health," Health Policy, Elsevier, vol. 88(1), pages 130-140, October.
    5. McColl-Kennedy, Janet R. & Hogan, Suellen J. & Witell, Lars & Snyder, Hannah, 2017. "Cocreative customer practices: Effects of health care customer value cocreation practices on well-being," Journal of Business Research, Elsevier, vol. 70(C), pages 55-66.
    6. Seale, Clive & Chaplin, Robert & Lelliott, Paul & Quirk, Alan, 2006. "Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists' experiences," Social Science & Medicine, Elsevier, vol. 62(11), pages 2861-2873, June.
    7. Allen, Dawn & Wainwright, Megan & Hutchinson, Thomas, 2011. "'Non-compliance' as illness management: Hemodialysis patients' descriptions of adversarial patient-clinician interactions," Social Science & Medicine, Elsevier, vol. 73(1), pages 129-134, July.
    8. repec:eee:aumajo:v:22:y:2014:i:3:p:230-237 is not listed on IDEAS


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