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This chapter summarises current knowledge about the causes of nonadherence. It draws on a range of narrative reviews and reports beginning with the seminal work of Haynes and Sackett (Haynes et al, 1976; Haynes, Taylor, and Sackett, 1979; Sackett and Haynes, 1976; Sackett and Snow, 1979) through to a recent report by the World Health Organisation (2003). The literature comprises hundreds of studies that have attempted to explain patients’ medication-taking behaviour and spans several disciplines, including medicine, pharmacy, nursing, epidemiology, anthropology, sociology and psychology.

Communalities across disciplines We initially attempted to map this literature according to its disciplinary origin and framework. However, detailed disciplinary mapping was not successful in view of the considerable overlap and interaction between approaches. For example, it is difficult to maintain a distinction between sociological and anthropological studies in this area as they share common frameworks and both employ qualitative methods. Common ideas and findings have also been found between psychological and sociological approaches to medicines use, making it difficult to draw rigid boundaries. We have therefore identified a broad distinction between (a) studies adopting an epidemiological/clinical approach and focusing on the causes of patient ‘default’from prescribed treatment regimes; and (b) studies that examine patients’ perceptions and intentions regarding their medicines use.