Figure 5.

A top-down model of adherence to therapies in chronic diseases.

In this model, the patient may be adherent to a given recommendation (eg, refraining from smoking, fastening seatbelt, exercising) by applying to each specific task the tactic of a personal rule. George Ainslie suggests that this tactic consists in considering the current choice of the larger, later reward over a smaller, sooner reward (see Figure 1), as a test case which predicts a whole bundle of larger, later rewards in the future (bundling tactic) described in Figure 4. In this example, the patient has three personal rules concerning smoking, exercising, and fastening seatbelt. By using a principle of foresight, the patient adopts a general, top-down, strategy giving priority to the future and thus bunching different therapeutic tasks, also including taking medicine, following diet etc. Note that the principle of foresight may also represent the driving force, which leads the patient to adopt individual bundling tactics (dotted lines). (Modified with permission from Reach 2007).