Bridging Communication Gaps Between Physicians and Patients to Improve Medication Adherence

Abstract

Medication adherence is widely recognized as essential to good clinical outcomes, yet gaps persist even when patients and physicians both consider it important. This study examines why that gap endures in Japan, focusing on three forces that shape
communication around adherence: the power dynamics of the patient–physician relationship, patient health literacy, and the role of digital tools. Using a cross-sectional quantitative survey of 200 patients and 60 physicians — stratified across oncology and lifestyle-disease care — and interpreting the results through Shared Decision Making, health literacy theory, the WHO Multidimensional Adherence Model, and the Technology Acceptance Model, the study finds that the gap is driven not by a lack of motivation but by misaligned perceptions. Physicians rate adherence as highly important yet doubt that patients understand instructions, while patients rate their own adherence very highly. Short consultations, a reliance on verbal confirmation, and cultural norms of deference and harmony combine to keep nonadherence hidden — a state of "false alignment."
The thesis reframes adherence as a communication and interaction-design challenge rather than a problem of patient compliance, and proposes a Communication Design Framework spanning the interaction, organizational, technological, and policy
levels to make adherence openly discussable and collaboratively managed.