Bulpitt, C. J. and Fletcher, A. E. (1988) – Reasons for non-adherence

Bulpitt, C. J. and Fletcher, A. E. (1988) ‘Importance of well-being to hypertensive patients’, American Journal of Medicine 29 (84), 40–6);



This is the first study we will be looking at from the Features of adherence to medical regimes section of ‘Healthy Living’, as part of your OCR A2 Health and Clinical Psychology course. It is further categorised into ‘Reasons for non-adherence

In this section of Health & Clinical Psychology, we will be considering why people will or will not adhere to medical regimes. Many people do not complete their full course of antibiotics and this is a thought to be a reason behind ‘superbugs.’

Some patients make rational decisions not to adhere to medical regimes, why could that be and how can this be prevented in the future.

In regard to medical regimes what is adherence? According to Haynes et al 1979 it is:

‘The extent to which the patient’s behaviour (in terms of taking medications, following diets or other lifestyle changes) coincides with medical or health advice’

The background for this study is Rational Choice Theory:

Rational Choice Theory suggests that people may not adhere to medical regime.

  • They have reason to believe the treatment is not working
  • The side effects are unpleasant or effect the quality of their lives
  • There are practical barriers to the treatment such as cost or social difficulties
  • They may want to check the illness is still there when they stop.



Patients may believe that doctor’s order do not serve their best interests and therefore they do adhere to the medical regime.

Bulpit  and Fletcher (1988)  looked at treatments for hypertension and found that the side effects could include impotence and problems with ejaculation.  Clearly for some men this would be seen as unacceptable!


To review research on adherence in hypertension patients.

Method and Design

A review article.

The research studied was research which identifying problems with taking drugs for high blood pressure.


The research was analysed to identify the physical effects of drug treatment on a person’s life: work, physical well-being, hobbies and more.


Anti-hypertension medication can have many side effects. Physical-sleepiness, dizziness, lack of sexual functioning. They also affect cognitive functioning, so work and hobbies are curtailed.


When the cost of taking medication, such as side-effects, outweigh the benefits of treating a mainly asymptomatic problem there is less likelihood of the patient adhering the their treatment.

Bulpitt and Fletcher (1988) Evaluation

– As the study used other research as the grounding for this research, we cannot be sure that any of the problems present in the secondary sources has not translated to this research.


Bulpitt, C. J. and Fletcher, A. E. (1988) ‘Importance of well-being to hypertensive patients’, American Journal of Medicine 29 (84), 40–6);

Further Reading

OCR A2 Psychology Student Unit Guide New Edition: Unit G543 Health and Clinical Psychology (Student Unit Guides)

Psych Yogi’s Top Ten Psychology Revision Tips for the A* Student

3 thoughts on “Bulpitt, C. J. and Fletcher, A. E. (1988) – Reasons for non-adherence

  1. Hi there, just wanted to ask who posed the rational choice theory and when? Thanks for your help

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