If the benefits outweigh the risks, good adherence behavior is more likely. In contrast, if the risks carry the day, a patient will almost certain be poorly adherent and may even refuse therapy. One important determinant of how an individual perceives relative benefits and risks is his or her experience with health professionals. Some people simply don't trust physicians. Others may have more positive feelings about but may be discouraged by poor access to health care and what may seem to be indifference on the part of the providers they do see.
Cultural factors are also critical.
Different subcultures and communities have collective perceptions of the medical profession that strongly influence individual attitudes and beliefs. Adherence behavior is also strongly influenced by family and community support. Caring friends, spouses, and relatives can provide the framework that will allow a patient to remain adherent to therapy. Without such help, adherence can be harder to achieve. I t is difficult to accurately measure adherence in a population of patients undergoing therapy for any disorder.