Contributions of public health to patient compliance.

This paper discusses the contributions of public health to compliance in five areas: clinical trials, smoking cessation, dietary compliance, breast cancer screening and hypertension control. Public health programs have been based on a number of theoretical foundations, most notably, social learning theory and the health belief model. Social marketing, community organization, and, more recently, consumer information processing models also are important. The strongest public health programs embody an ecological approach, with interventions directed not only at individuals, but also at groups, communities and changing institutional norms. Among the most important contributions of public health interventions are: multiple levels of intervention and evaluation, tailoring to target audiences, use of social support and community organization for behavior change. Together, community health and clinical compliance-enhancing strategies can exert a synergistic impact on health behavior change.