3.2.3 Improving adherence

Question 1

Improving adherence

Ley (1988) argued that patients are…?

Rather than…?

Answer 1

‘Information seekers’ = they want to know as much about their disorders and any subsequent treatment as possible, rather than being ‘information blunters’ who wanted to be kept from the truth.

Question 2

Using the behaviourist approach to improve adherence

What are techniques suggested by the behaviourist apprach that we could use to improve adherence?

Answer 2

• Feedback and self-monitoring
• Contigency contracts
• Modelling
• Direct reinforcements/incentives
• Punishment

Question 3

Using the behaviourist approach to improve adherence

Feedback and self-monitoring

Answer 3

The patients gets regular reports on the state of their health so reinforcing their adherence.

Question 4

Using the behaviourist approach to improve adherence

Contingency contracts

Answer 4

The patient negotiates a contract with a health worker concerning goals and rewards for achieving their goals.

Question 5

Using the behaviourist approach to improve adherence

Modelling

Answer 5

The patient sees someone else who is successful in a support group or as a mentor etc.

Question 6

Using the behaviourist approach to improve adherence

Direct reinforcements/incentives

Answer 6

Like being given more money to continue on a programme or come off drugs.

Question 7

Using the behaviourist approach to improve adherence

Punishment

Answer 7

Take medication or face compulsory admission to hospital, for example.

Question 8

Individual behavioural techniques

Customising treatments

Answer 8

Adapting the course of treatment to suit the patient’s lifestyle.

Question 9

Individual behavioural techniques

Evidence to support customising treatments

Answer 9

Shi (2007) simplifying dosage frequency can improve adherence.

Question 10

Individual behavioural techniques

Contracts

Answer 10

Can be discussed between the Dr and patients and then signed or kept to a verbal agreement.

Question 11

Individual behavioural techniques

Evidence to support contracts

Answer 11

Bosh-Capblanch et al. (2007) carried out a review of previous studies (meta-analysis) and found that the use of contracts did generally increase adherence, but little evidence of long-term improvement.

Question 12

Individual behavioural techniques

Prompts

Answer 12

Reminders through texts, emails, phone calls, medication boxes etc.

May help when the key cause of non-adherence is forgetting.

Question 13

Individual behavioural techniques

Evidence to support prompts

Answer 13

Strandbygaard found that prompts did improve adherence to medication in asthma sufferers, but other evidence is inconclusive.

Question 14

Chaney et al. (2004)

Aim

Answer 14

To compare the adherence of children with asthma using the Funhaler to those using the traditional spacer.

Question 15

Chaney et al. (2004)

Funhaler

Answer 15

Same as standard asthma inhaler, except the spacer has the addition of a whistle and toy element, aiming to make it more fun for children to use.

Question 16

Chaney et al. (2004)

Method

Answer 16

Field experiment

Question 17

Chaney et al. (2004)

Participants

Answer 17

• 32 children aged 1.5 to 6 years-old
• Had asthma
• Used a standard spacer

Question 18

Chaney et al. (2004)

Sampling method

Answer 18

Randomly recruited through 7 local clinics.

Question 19

Chaney et al. (2004)

What were parents asked to complete?

Answer 19

A questionnaire including closed questions about attitudes and adherence to the recommended treatment.

Question 20

Chaney et al. (2004)

What were children instructed to do?

Answer 20

Use the Funhaler for 2 weeks and complete the initial questionnaire again.

Question 21

Chaney et al. (2004)

How were parents contacted? What were they asked?

Answer 21

By telephone on an ad hoc basis whilst their child was using the standard treatment and the Funhaler, to be asked if their child had taken their treatment on the previous day.

Question 22

Chaney et al. (2004)

Results

Answer 22

Yes.

59% of children on their standard treatment had been medicated the previous day, this rose to 81% using the Funhaler.

Question 23

Chaney et al. (2004)

Conclusion

Answer 23

The Funhaler is effective in increasing adherence to asthma treatment in children.

Question 24

YOKLEY AND GLENWICK (1984)

Immunisation deficient

Answer 24

Children who were found to be in need of at least one immunisation.

Question 25

YOKLEY AND GLENWICK (1984)

Community interventions

Answer 25

Any attempts to encourage a certain behaviour in a town or city, using methods such as leafleting, letters and lotteries.

Question 26

YOKLEY AND GLENWICK (1984)

Aim

Answer 26

To investigate the impact of 4 conditions on motivating parents to have their children immunised.

Question 27

YOKLEY AND GLENWICK (1984)

What were the 4 conditions?

Answer 27

1. Mailed prompt
2. Mailed specific prompt
3. Mailed specific prompt plus expanded clinic hours and convenience.
4. Mailed specific prompt plus lotter ticket (monetary incentive).

Question 28

YOKLEY AND GLENWICK (1984)

Participants

Answer 28

• 2,101 pre-school immune-deficient children in America.
• 50% female
• 64% white
• Needed one or more innoculations for tetanus, whooping cough, measles, mumps, rubella, polio or diphtheria.

FINAL SAMPLE 715?

Question 29

YOKLEY AND GLENWICK (1984)

Method

Answer 29

Longitudinal field experiment.

Question 30

YOKLEY AND GLENWICK (1984)

Which group had the biggest impact?

Answer 30

The monetary incentive group.

Followed by increased access group, specific prompt group, general prompt group and lastly the control groups.

Question 31

YOKLEY AND GLENWICK (1984)

Which groups caused a 29% increase in the no. of immunisations given?

Answer 31

Specific prompt and monetary incentive methods.

Question 32

YOKLEY AND GLENWICK (1984)

Which method was the most cost-effective?

Which was the least?

Answer 32

Specific prompt group was the most cost-effective.

Monetary incentive was the least cost effective in the long run.

Question 33

YOKLEY AND GLENWICK (1984)

Conclusion

Answer 33

• Using behavioural incentives to motivate parents to immunise children is effective.
• A single general prompt is not enough to motivate parents to immunise children.

Question 34

YOKLEY AND GLENWICK (1984)

Strengths

Answer 34

• Standardised procedure = high reliability because research it replicable.
• Generalisable = large-scale study on huge population of immune-deficient children, providing lots of data.
• Longitudinal study = increases validity since we can learn long-term effects.
• RWA = could help influence approaches used by health care providers to improve immunisation rates.

Question 35

YOKLEY AND GLENWICK (1984)

Criticisms

Answer 35

• Cultural bias = findings may not generalise to other parts of the USA or other countries. The final sample was smaller so also may not represent the target population.
• Unethical = used children, parents did not consent to participate, they were unaware their behaviour was being manipulated, questionable whether it is ethical to encourage a group using money.

Question 36

Issues and debates

How does Yokley and Glenwick’s study have RWA?

Answer 36

Suggests ways that adherence could be improved in immunisation-deficient children.

Question 37

Issues and debates

What is it reductionist to assume about adherence?

Answer 37

That non-adherence is as simple as making a rational choice.

The reason for adherence may be a complex interaction between past positive or negative experiences (behaviourism) and early trauma (psychodynamic) combined with biological side effects which may be very individual to one particular person.