Because of the evolution of hospitals from general care to acute care centers, the need for more outpatient therapy programs had increased in an effort to aid patients in managing their health care at home. As a result, health care professionals were concerned with the extent to which patients would follow their medication and treatment programs. Marston estimated that approximately 30 to 35 percent of patients fail to follow their physicians' medical recommendations (Marston, 1970).

Discovering a means of insuring patient compliance was a prevalent concern in the nursing and medical professions. Previously we had attempted to blame noncompliance on physiological and/or psychological factors with an excuse that nothing can be done to promote patient compliance. Researchers investigated many factors affecting patient compliance such as sex, race, education, psychological variables, physician-patient interaction, attitudes, and nursing interventions.

The nurse came into closer and more frequent contact with patients than did the physician, and thus ought to be in a position to influence their health behaviors toward compliance. Nursing staff might work with the patient in the scheduling of treatments and medications coordinated with daily activities in an attempt to positively affect patient compliance. Another potentially important contribution of nurses to patient compliance was that of assisting them to understand both the nature of their illnesses and the reasons for their treatment. Nursing staff who were in repeated contact with the patient could institute such education and make themselves available and approachable for the expression of questions, doubts, and fears. The overall objective of the current compliance study was to compare the efficacy of individual instruction on compliance with that of group instruction in patients with chronic obstructive pulmonary disease (C.O.P.D.). The study was also aimed at looking at the effect of symptomatology, physical findings, pulmonary function, and locus of control on compliance.

The research method implemented in the compliance study in the C.O.P.D. patient was quasi-experimental and correlational. The 36 randomly assigned participants were alternately assigned to an experimental or control group. The experimental group contained 18 patients receiving individual instruction and the control group contained 18 patients receiving group instruction. The research design was the randomized control-group pretest-posttest design. The participants were then randomly assigned to test times and rooms as they were individually evaluated over a three-month period.

Analysis of the data concluded that there was no significant difference (α=.05) in the degree of compliance with the medical treatment regimen in the C.O.P.D. patient resulting from instruction given on an individual basis and that given in a group as measured by the following factors: pill counts, liquid medication measurements, breathing machine meter readings, and number of cigarettes smoked.

There was no significant relationship between a C.O.P.D, patient's degree of symptomatology or change in physical findings and his compliance with the medical treatment regimen. Neither was there a significant relationship between the pulmonary function (FEV1 and FVC) in the C.O.P.D. patient and his compliance. The Rotter I:E Score had no significant effect on the C.O.P.D. patient's compliance to his medical treatment regimen.

Findings that were significant included the Rotter l:E Score, the FVC, and the degree of symptomatology that significantly affected pill taking only and the individual instruction that significantly affected the use of the liquid medication only. The lack of significant findings could be related to the wide variability of compliance among patients in both groups. The study of a larger number of patients for a longer period of time could compensate for this variability.

A conclusion derived from the current compliance study was that group instruction for the C.O.P.D. patient might be more economical and just as effective as individual instruction which required more time and staff. We could not rely upon a patient's increase in symptoms or changes in his physical findings as a means of insuring compliance. In this study, pulmonary function had no significant effect on whether a patient would comply or not.

The locus of control significantly affected the pill taking of the C.O.P.D. patients. Research into the use of the locus of control could aid in the development of solutions for noncompliance problems. Teaching methods could be directed at an individual's locus of control as a means of promoting compliance.

The implications for nursing were that nurses must be open to clues from the patient as to why he is noncompliant. Speaking to him about possible problems that may interfere with him following his program and working on solutions with the patient should prove helpful. Nurses should become more involved in problem-solving programs, because the nurse has many opportunities to speak with the patient about this particular subject.

LLU Discipline





Graduate School

First Advisor

Evelyn L. Elwell

Second Advisor

Eileen G. Zorn

Third Advisor

John E. Hodgkin

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Lung Diseases; Patient Compliance; Patient Dropouts



Page Count

vii; 86

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives