Adherence Flashcards
What is the definition of adherence and who said it?
Horne et al (2005) said adherence is the degree to which the patients behaviour matches an agreed treatment plan.
What did adherence used to be referred to?
Who said it?
Why did it change?
Compliance (Haynes & Sackett, 1979) was the extent to which the patients behaviour matches the practitioners advice.
Changed because adherence is much more PC and focuses on SDM with an ‘agreed’ treatment plan.
What is the global problem of non adherence? 3 references
WHO (2003) said medical non adherence is a ‘worldwide problem of striking magnitude’
Haynes et al (2008) estimated that between 30-50% of medicines for CIs are not taken as directed in the UK
Trueman et al (2010) this costs £630 million in England alone
Who said determinants of medical non-adherence are complex?
Donavan et al., (2022)
What is one determinant of adherence which is based in theory about necessity and concerns? Who came up with it?
Horne et al (2013) came up with the Necessity-Concerns Framework. This posits that medication adherence will be greater when the patients beliefs in the necessity of the medication exceeds their concerns.
What is a strength of the NCF as a determinant of adherence?
Copius amounts of research evidence for it being applied to many illness domains including HIV (Gonzalez, 2007) and strokes (O Carrol, 2011)
Has there been a meta-analysis which supports the NCF as a determinant of adherence?
Is there any problems with this meta-analysis?
Foot et al (2016) found that necessity beliefs were positively correlated with adherence and that concern beliefs were negatively correlated with adherence.
However, the effect sizes were small which may have been due to some of the included studies having a small effect size, this may have led to an underestimation of the true effect size.
What is a criticism of the NCF as a determinant of adherence and who said it?
Easthall & Barnett (2017) said NCF does not consider a patients unconscious decisions to adhere (e.g. forgetting) so is less useful to practical barriers of adherence.
What is another suggested determinant of adherence that is grounded in theory, this time it is behaviour change theory.
Jackson et al (2014) applied how adherence factors (e.g. forgetting), that were extracted from previous literature, could be mapped onto the COM-B model (Michie et al., 2011).
COM-B model says individuals must have the capability, opportunity and motivation to change their behaviour, i.e. taking their medication.
What is a weakness of using the COM-B as a determinant of adherence?
Who said it?
Ogden (2016) said the COM-B model overlooks the influence of ‘human variability’ and therefore this reduces its effectiveness as an explanation of adherence for all patients.
What is a strength of applying the COM-B as a determinant of adherence?
Who said it?
Jackson et al (2014) said the COM-B has provided a comprehensive explanation of adherence and has included automatic processes such as habit which other frameworks like the NCF did not.
Who recently used a the COM-B model to develop an AI? and what did they find?
Were there any problems with this study?
What was a good thing about this study?
Whittal et al (2021) applied the COM-B to develop an AI to improve self-care in heart failure patients.
They found it useful for identifying factors influencing adherence, e.g. salience of consequences.
However, the study had a small sample size which did not allow for robust statistical tests to be carried out on.
BUT it was based in theory which increases the effectiveness of AI (Abraham et al., 2009)
Who used the NCF to develop an AI? and what did they find?
Were there any problems with this study?
What was a good thing about this study?
Clifford et al (2006) found that AI that focused on the patients beliefs about necessity and concerns by meeting the patient’s needs for information and advice has been effective.
However, this study did not consider unconscious determinants of adherence (e.g. forgetting)
BUT it did encouraging aspects of SDM which has been previously linked with adherence (Bauer et al., 2014). So theory is useful.
Who found that not all AIs are effective in 2008? What did they find in their Cochrane review?
Any problems with this study?
Haynes et al (2008) carried out a Cochrane review of RCTs.
They found that less than half of the included interventions led to improved adherence.
Also found that less than a third led to improvements in at least one treatment outcome.
Also, not all of the ‘effective’ AIs considered clinical outcomes and so this makes drawing concrete conclusions about effectiveness difficult.
Authors said this study was relatively narrow as they may have missed trials due to their strict criteria.
Has there been a recent effective AI? Who did it and what did they find?
Any problems with this study?
Thakkar et al (2016) did a text messaging based AI and found that it was effective, with an approximate doubling of the odds of the patients achieving adherence to their medication regimens.
BUT they included trials with short durations and so there is uncertainty about the duration of the effect and the continuation or decay of that effect after the AI is withdrawn. So hard to see long term effects on adherence behaviour.
