BASE™: Behavioral Architecture & Stability Evaluation

In an era where medication adherence remains one of the most elusive variables in chronic disease management, BASE™ (Behavioral Architecture & Stability Evaluation) introduces a new framework for understanding not only whether patients take their medication, but how their adherence behavior is organized and sustained over time.

Most tools, including the gold standard MMAS-8, focus on retrospective recall or binary adherence thresholds. BASE breaks from this tradition by asking a different question: how resilient is a patient’s behavioral ecosystem when it comes to medication-taking?

BASE was designed to uncover dynamic, situational, and hidden non-adherence behaviors that often precede measurable declines in adherence or outcomes. Traditional self-report tools ask if the medication was taken; BASE investigates whether a patient’s routine is structurally capable of withstanding real-world stressors.

BASE functions as a behavioral seismograph, registering early tremors in adherence patterns before they manifest clinically. The conceptual foundation rests on the insight that behavioral stability is not the same as adherence success. A patient may report full adherence today but may be one disruption away from collapse. BASE captures this fragility, quantifies it, and introduces a scalable framework for early detection and intervention.

Answer each question as honestly as possible, thinking about your typical behavior over the past 30 days. Your responses are confidential and will guide your care.

Memory

Question: Do you usually remember to take your medication when scheduled, even under stress?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Routine

Question: Can you maintain a consistent routine for taking medication in changing circumstances?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Symptom Resilience

Question: If you start feeling better, can you stay on your medication as prescribed?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Flexibility

Question: Can you adjust your daily routine to ensure medication is taken as needed?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Tolerance

Question: If you experience side effects, can you continue treatment while managing them?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Integration

Question: Does taking medication fit naturally into your daily life?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)

Preparedness

Question: Do you routinely maintain a backup supply to prevent running out?
Score: ☐ Yes (1.0) ☐ Sometimes (0.5) ☐ No (0.0)
 

Scoring & Use:

• BASE_raw = sum of item scores (range 0–7)
   
• BASE_norm = BASE_raw ÷ 7 (range 0–1)
   

Administer monthly or at baseline plus monthly follow-up. BASE_norm can serve as the X-axis anchor in adherence geometry or as a longitudinal behavioral metric.

Behavioral Descriptors:

BASE_norm     Raw Score (0–7)     Descriptor                                   Interpretation

0.00–0.25         0–1.75                         Weak Foundation                    Very limited behavioral capacity

0.26–0.50         2–3.5                            Fragile Foundation                  Gaps in behavioral skills

0.51–0.75         3.5–5.25                    Developing Foundation         Reasonably stable

0.76–1.00         5.25–7                         Strong Foundation                   Solid behavioral capacity 

A change of ≥1.0 point in either direction is considered clinically meaningful, indicating improvement or deterioration in adherence stability.

BASE draws upon behavioral ecology and cognitive resilience theory, viewing patients as systems of interacting routines, environment, emotion, memory, and habit. These systems are often stable until disrupted, at which point fragility becomes visible. By anchoring questions in situational realities rather than generic queries, BASE reduces social desirability bias and increases ecological validity.

Unlike retrospective adherence tools, BASE does not replace them. It complements them by providing forward-looking insight into behavioral vulnerability, measuring the stability of adherence rather than performance. It is the first instrument designed to quantify the structural resilience of medication-taking behavior.

BASE is versatile across healthcare and research settings:

• Follow-up to MVMT or STRATA, identifying hidden behavioral fragility in patients reporting high adherence
   
• Integration into digital health platforms for real-time behavioral monitoring
   
• Embedded in Remote Therapeutic Monitoring (RTM) protocols
   
• Clinical decision support in primary care, pharmacy, or behavioral coaching
   

BASE is particularly powerful in populations with situational or hidden non-adherence, such as patients managing polypharmacy, chronic illness, or mental health disorders under socio-economic stress.

BASE is not a replacement for existing adherence measures. It is a new dimension, asking not just whether patients are adherent but how resilient their adherence truly is. It provides clinicians, researchers, and digital innovators with a behavioral compass to guide proactive and personalized intervention.

BASE™ is the intellectual property of Philip Morisky and is exclusively distributed through Adherence Cartography. Unauthorized use, reproduction, or distribution is strictly prohibited.