Selection Bias

Selection bias may influence the results of intervention research in studies in which subjects may not have major adherence issues. This potential for bias is almost always an issue, because those subjects who agree to enroll in studies are generally motivated and therefore are likely to be at lowest risk of nonadher-ence. This factor is particularly important in studies that involve elaborate and labor-intensive procedures (e.g., lengthy mental health assessment protocols, complicated treatments), which may lead the least adherent patients to drop out. Selection bias is a problem in adherence studies that are "piggy-tailed" onto existing drug studies, because drug manufacturers typically ensure, prior to enrollment, that the patients who are enrolled in their study are likely to be adherent. When evaluating a manuscript related to nonadherence, the reader should therefore pay close attention to the problem of selection bias.

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