Voluntary and Involuntary Nonadherence: Terminology for Labeling Patient Participation

The descriptions and labels healthcare providers place upon patients can greatly determine the quality and availability of the healthcare they receive. When that patient is given the label nonadherent or noncompliant within healthcare, it can have a detrimental impact on the patient. But patient adherence is a more complicated issue than can be express with a binary determination; is or is not, yes or no. Therefore, additional terminology should be utilized to properly convey the patient’s participation status when the patient does not fully engage in care. This paper proposes the implementation of additional qualifying language: involuntary nonadherence and voluntary nonadherence. Involuntary nonadherence is defined as when the patient desires to participate in care but is unable to do so because of factors outside of his/her control. These could involve inadequate means of transportation, difficulties with schedule flexibility, etc. These patients are demonstrating nonadherence by current standards but would participate if circumstances allowed – outside pressures are influencing the decision to be nonadherent. Contrast that with voluntary nonadherence, defined as when the patient gives informed refusal to participate, and the patient is fully able to participate but actively chooses not to. This additional qualifying language could ensure protection for patients from being labeled and potentially dismissed due to circumstances outside of their control.