Selection of pillsMany people diagnosed with an illness do not adhere to the treatment recommendations given by their health care provider.

This is problematic both in the context of research - like in trials that evaluate the effectiveness of a new drug – and in clinical practice, where people do not experience the potential health benefits that could be achieved by strict adherence, and as such, health care costs increase substantially.

Our research focuses on the accurate measurement of adherence behaviours in the context of trials (both drug and behavioural), observational studies, and clinical practice; identification of factors at the patient, treatment, health care provider, and health care organization level that influence adherence behaviours; and developing and testing of interventions to change these factors to enhance adherence, people’s health and well-being, and the efficiency of care.

Current projects in this area include:


ASTRO-LAB is an EU funded project in which Prof. de Bruin and colleagues from the University of Amsterdam examine how adults and children with asthma self-manage their condition, key determinants of their self-management behaviours, how self-management is influenced by health care provider communication, and how patients’ adherence to medication is related to safety of medication use. For the project website, see


AIMS, the Adherence Improving self-Management Strategy, is a potent behavioural intervention to promote adherence to medication for chronic conditions. The intervention has been developed by Prof. de Bruin and gone through various stages of testing (pilot and effectiveness), and its’ cost-effectiveness is currently being evaluated in a multi-centre trial among patients treated for HIV in the Netherlands.

Sample Publications:

  • O'Carroll, RE., Chambers, JA., Dennis, M., Sudlow, C. & Johnston, M. (2014). 'Improving Medication Adherence in Stroke Survivors: Mediators and Moderators of Treatment Effects'. Health Psychology, vol 33, no. 10, pp. 1241-1250.
    [Online] DOI: 10.1037/hea0000082
  • Dima, AL., Hernandez, G., Cunillera, O., Ferrer, M., de Bruin, M. & the ASTRO-LAB group (2014). 'Asthma inhaler adherence determinants in adults: systematic review of observational data'. European Respiratory Journal, vol 45, no. 4, 01751-2014, pp. 994-1018.
    [Online] DOI: 10.1183/09031936.00172114
  • O'Carroll, RE., Chambers, JA., Dennis, M., Sudlow, C. & Johnston, M. (2013). ‘Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial’. Annals of Behavioral Medicine, vol 46, no. 3, pp. 358-368.
    [Online] DOI: 10.1007/s12160-013-9515-5
  • Oberje, EJM., de Kinderen, RJA., Evers, SMAA., van Woerkum, CMJ. & de Bruin, M. (2013). 'Cost Effectiveness of Medication Adherence-Enhancing Interventions: A Systematic Review of Trial-Based Economic Evaluations'. Pharmacoeconomics, vol 31, no. 12, pp. 1155-1168.
    [Online] DOI: 10.1007/s40273-013-0108-8
  • de Bruin, M. & Viechtbauer, W. (2012). 'The meaning of adherence when behavioral risk patterns vary: Obscured use- and method-effectiveness in HIV-prevention trials'. PLoS ONE, vol 7, no. 8, e44029.
    [Online] DOI: 10.1371/journal.pone.0044029
  • Lyimo, RA., de Bruin, M., van den Boogaard, J., Hospers, HJ., van der Ven, A. & Mushi, D. (2012). 'Determinants of antiretroviral therapy adherence in northern Tanzania: a comprehensive picture from the patient perspective'. BMC Public Health, vol 12, 716.
    [Online] DOI: 10.1186/1471-2458-12-716
  • de Bruin, M., Viechtbauer, W., Schaalma, HP., Kok, G., Abraham, C. & Hospers, HJ. (2010). 'Standard care impact on effects of highly active antiretroviral therapy adherence interventions: A meta-analysis of randomized controlled trials'. Archives of Internal Medicine, vol 170, no. 3, pp. 240-250.
    [Online] DOI: 10.1001/archinternmed.2009.536
  • de Bruin, M., Hospers, HJ., van Breukelen, GJP., Kok, G., Koevoets, WM. & Prins, JM. (2010). 'Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial'. Health Psychology, vol 29, no. 4, pp. 421-428.
    [Online] DOI: 10.1037/a0020335