Negotiating compliance in heart failure: remaining issues and questions.

Living with heart failure (HF) means living with a chronic illness characterized by periods of acute decompensation alternating with periods of relative stability. Improved medical care for patients with cardiovascular diseases, coupled with the aging of the populations in the developed world, has resulted in a steadily increasing prevalence of HF. Rehospitalization rates are high for this patient population. In 20-64% of the cases, poor compliance by patients with the prescribed HF treatment is a contributing factor to hospitalization. This article uses a review of the literature on HF non-compliance, including the prevalence, barriers, consequences, and the long-term outcomes of non-compliance with HF therapy, to illustrate remaining issues and questions. Original studies published in English or German between 1966 and June 2004 identified by combining patient compliance, non-compliance, adherence, self-care, rehospitalization, patient education, and management programs, with heart failure in the search strategy are included. Creative approaches to achieving a true partnership between providers and patients are needed if clinical outcomes are to improve.

Moratorium-achievement (MAMA) cycles in lifespan identity development: value orientations and reasoning system correlates.

Three important questions emerging in identity research are: Why do only some persons with Foreclosed identities move on to Identity Achievement? Why do some Identity Achievement persons move "back" to Foreclosure? How can life-span identity re-formulation be accounted for? This study proposes that individual's positions on two variables, "instrumental vs. experiential orientation" and formistic vs. dialectrical thinking, may be important in answering these questions. Among 60 university students, 23 males and 37 females, those in an identity status characterized by formation and maintenance of structure (Foreclosure) were instrumentally-oriented while those characterized by openness to change and revision (Moratorium) were experientially-oriented. Similarly, more Moratoriums than other statuses were high in dialectic thinking. These results are discussed in terms of their theoretical implications for life-span identity development.

Adaptive regression and ego identity.

An inventory of adaptively regressive experiences (Taft Ego Permissiveness Inventory) and the Identity Status Interview were administered to 71 college students (35 female, 36 male). As hypothesized, Moratorium status individuals (actively engaged in identity formation) showed a greater disposition to adaptive regression than did individuals in other statuses. This supports the view that adaptive regression may serve an important function in the identity formation process. Contrary to hypothesis, Achievement status individuals did not show greater disposition to adaptive regression than those in Foresclosure status. Females showed substantially greater disposition to adaptive regression than did males.

Identity and intervention.

The evidence, I thought, seemed clear enough. Frazier had claimed some innovations in behavioral techniques which I wanted to know more about, but I could imagine a potent technology composed of the principles already used by politicians, educators, priests, advertisers and psychologists. The techniques of controlling human behavior were obvious enough. The trouble was, they were in the hands of the wrong people--or of feeble repairmen.

The relative importance of identity status interview components.

Eighty college males were given an expanded identity status interview which included two new interpersonal-sexual areas, "attitudes towards sexual expression" and "sex-role beliefs." The relative contribution of the new content areas as well as of the standard three areas (occupation, religion, and politics) to overall identity status was assessed by noting the extent of correspondence. Identity status in each content area was also compared with performance on the dependent variable of cognitive complexity. Ideology contributed more than occupation both to overall status rating, as well as to discrimination on the dependent variable. Results on the two new areas supported the view that interpersonal-sexual concerns are important for men's identity development as well as for women's. The finding that all interview areas corresponded well with overall identity status and discriminated significantly on the dependent measure leads to the suggestion that the process variables of crisis and commitment may so overshadow a particular content area that any content of personal relevance for the late adolescent might be used in investigating ego identity development.

Ego identity status, formal operations, and moral development.

Twenty-six subjects (20 males and 6 females) were administered measures assessing ego identity status, level of moral reasoning, and stage of cognitive development. Expectations that formal operations would be a necessary but not a sufficient condition for the development of post-conventional moral thought and for Identity Achievement status were supported. Level of moral thought was also found to be positively related to achievement of identity. Individual descriptions of subjects with noteworthy patterns of the three variables under study were presented. Suggestions for future research included the necessity for replication of these findings with a largerN and exploration of the possibility that level of social role taking mediates between cognitive development and identity (psychosocial) development.

Identity six years after: A follow-up study.

Thirty male subjects, given identity status interviews 6-7 years previously, were reinterviewed for identity status, as well as intimacy status, life style, and participation in the 1969-1970 campus demonstrations. High identity status appeared more vulnerable to change than did low. The Moratorium status showed a 100% change rate. The establishment of intimate relationships was related both to previous identity status (when that status remained stable) and to current identity status. In life style, Identity Achievement and Moratorium subjects were "open"; Foreclosure subjects were "closed"; and Identity Diffusion subjects tended to be "diffuse". Subjects currently high in identity tended to feel more positively about and participated more in the 1969-1970 demonstrations than did lower identity status subjects. A new status, Foreclosure/Diffusion, is described. The theoretical anomaly of Identity Achievement and Moratorium subjects moving into the Foreclosure status has led to the suggestion of a process, as opposed to typological, approach to identity. Brief sketches of individuals as they currently appear in the identity statuses conclude the study.