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To the Editor: Dr O'Malley and colleagues¹ found that coronary calcification screening with electron beam tomography (EBT) did not result in significant changes in individuals' modifiable risk factors. As Greenland noted,² adherence to therapies is a multidimensional challenge. A single "motivational jolt" such as EBT would be expected to rapidly fade without producing any behavioral change.

To address this problem, the World Health Organization report on adherence to long-term therapies³ used 5 dimensions to describe the challenges of improving adherence. The evidence we reviewed in the report also suggests that concerted action for improving adherence would improve both health and economic outcomes for a wide range of medical conditions.

Comprehensive interventions combining cognitive, behavioral, and affective (motivational) aspects are more effective than single-focus interventions.⁴ Although continuous efforts are being made to improve the provision of information to patients, motivation, which drives sustainable good adherence, is one of the most difficult . . . [Full Text of this Article]

Eduardo Sabaté, MD, MBA, MPH
World Health Organization

Derek Yach, MBChB, MPH
Noncommunicable Conditions and Mental Health Cluster
World Health Organization
Geneva, Switzerland

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