STRATA™: Social and Treatment Relational Access and Terrain

STRATA™ measures the contextual support environment of patients. The social and practical forces that stabilize or destabilize adherence behavior. While BASE™ captures predictive behavioral stability and MVMT™ captures recent adherence patterns, STRATA completes the triad by illuminating the external relational and environmental factors that influence adherence outcomes.

Medication adherence is not solely a product of personal intention or habit. Patients operate within social networks, logistical constraints, and resource landscapes that either reinforce or undermine their adherence routines. STRATA provides a structured, patient-reported view of that environment, offering insight into areas that may support or compromise medication-taking behavior.

As the third pillar in the Cartographic Behavioral Framework, STRATA ensures that adherence is understood not just as a behavior, but as a product of the interaction between individual capacity, recent behavior, and relational context.

Conceptual Importance

STRATA recognizes that:

1. Adherence is socially embedded: The presence, reliability, and quality of support systems—family, friends, caregivers—directly affect behavioral stability.
    
2. Resources and logistics matter: Transportation, medication affordability, and management tools determine whether intentions translate into action.
    
3. Context shapes vulnerability: Patients with strong BASE scores and stable MVMT patterns may still be at risk if relational and resource supports are weak.
    

By combining STRATA with BASE and MVMT, Adherence Cartography captures the complete adherence ecosystem, creating a detailed map of stability, fragility, and actionable risk.

STRATA™ Domains & Assessment

1. Primary Support Person — Who helps you remember or manage medications?
    
   • Spouse/Partner
   • Adult Child
   • Other Family Member
   • Friend/Neighbor
   • Caregiver
   • I manage on my own
   • No one helps me
      

1. Contact Frequency — How often do you have meaningful contact with family or friends?
    
   • Daily
   • Several times a week
   • Once a week
   • A few times a month
   • Rarely
   • Almost never
      

1. Living Situation — What is your current living arrangement?
    
   • Live with spouse/partner
   • Live with family members
   • Live alone but nearby family
   • Live alone, family far away
   • Assisted living
   • Homeless or unstable housing
      

1. Emergency Contact Network — If you missed an appointment or had an emergency, who would notice?
    
   • Multiple people quickly
   • At least one person
   • Someone eventually
   • Probably no one
   • Definitely no one
      

1. Transportation Access — How do you usually get to medical appointments or the pharmacy?
    
   • Drive myself
   • Family/friends drive me
   • Public transportation
   • Medical transport/taxi
   • Difficulty accessing transportation
   • Cannot get to appointments
      

1. Financial Resources — Can you afford medications each month?
    
   • Yes, without difficulty
   • Yes, but a stretch
   • Sometimes struggle
   • Often cannot afford
   • Cannot afford
      

1. Medication Management Tools — What systems do you use to manage medications?
    
   • Pill organizer + reminders
   • Pill organizer
   • Phone/timer reminders
   • Written notes/calendar
   • Try to remember
   • No system
      

1. Health Literacy — Do you understand your medications and why you take them?
    
   • Yes, completely
   • Understand most
   • Understand some
   • Understand very little
   • Don’t understand at all
      

Each item is scored to reflect supportive versus fragile context. Higher scores indicate stronger relational and resource support; lower scores indicate vulnerability that may compromise adherence even when BASE and MVMT are strong.

• STRATA_norm: normalized score (0.0–1.0)
   
• 0.00–0.25: Highly vulnerable – minimal social or practical support
   
• 0.26–0.50: Unstable – inconsistent support; multiple risks
   
• 0.51–0.75: Moderately stable – some protective relational or resource factors
   
• 0.76–1.00: Strong – robust support network and access to resources
   

STRATA enables:

• Clinical Risk Identification: Detect patients at risk due to fragile social or resource support
   
• Digital Health Integration: Map patient support landscapes to guide interventions and notifications
   
• Population Health Analysis: Identify communities or subgroups with systemic adherence vulnerabilities
   
• Behavioral Phenotyping: Understand adherence risk as a function of relational and contextual factors
   
• Program Design: Tailor social, logistical, and educational supports to reinforce adherence stability
   

• BASE™: Behavioral “video” of predictive stability
   
• MVMT™: Behavioral “snapshot” of recent adherence
   
• STRATA™: Behavioral “ecosystem map” of social and tangible supports
   

Together, these three instruments provide a comprehensive map of adherence, showing not just whether patients take their medications, but how personal capacity, recent behavior, and relational context interact to create stability or fragility.

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