adherence Flashcards
what do the “Rider” and “Elephant” represent in behaviour theory?
rider = rational brain (logic), elephant = emotional brain (instinct)
both must be aligned for behaviour change
why is the rational brain not enough to change behaviour?
because emotional beliefs often overpower logic, especially if there’s a disconnect
what is a “nudge”?
a way of making the right behaviour the easy/default option using environmental cues (choice architecture)
give an example of a successful nudge
piano stairs or hope soap — both make the desired action fun and easy
what does MINDSPACE stand for?
messenger
incentives
norms
defaults
salience
priming
affect
commitment
ego
what’s an example of the “Norms” principle from MINDSPACE?
“many people like you take daily ICS” → encourages behaviour by showing it’s the norm
when is it unethical to use a nudge?
when it promotes behaviour that could cause harm or bypasses informed choice
what is libertarian paternalism?
helping people do what’s best without removing their freedom to choose
why should nudge follow informed decision-making?
because beliefs influence whether the patient will accept the nudge
what two belief types does the NCF balance?
necessity beliefs vs. concerns
what leads to higher adherence in NCF?
when perceived necessity > concerns about treatment
give examples of “common-sense” defaults that reduce adherence
“no symptoms = no problem”, “natural is safer than chemical”, “If I still feel ill, it’s not working.”
how do these defaults affect medication-taking behaviour?
they create cognitive barriers that outweigh clinical advice unless directly addressed
what causes the behavioural gap in adherence?
disconnect between patient beliefs and prescriber expectations
why don’t patients always share non-adherence?
fear of being judged or not wanting to disappoint the HCP
what 3 domains affect adherence?
1) healthcare system
2) HCP–patient relationship
3) patient beliefs/practicalities
what are the 3 steps in the PAPA model?
1) address perceptions (necessity & concerns)
2) tailor to practical needs
3) use a no-blame approach
what’s the goal of PAPA?
to turn an informed choice into consistent, practical adherence behaviour
what’s the path to forming a habit in adherence?
motivation → ability → habit
what tools support habit formation?
reminders, prompts, environment (e.g. meds near toothbrush), pharmacist support
why do young patients underuse ICS and overuse SABA?
they feel immediate relief with SABA and may not see the need for preventive ICS
what is the aim of the Illness and Treatment Balance Model (ITBM)?
reframe asthma treatment to show ICS as essential and SABA as limited to symptom relief
how does ITBM shift beliefs?
↑ ICS necessity, ↓ ICS concerns, ↓ SABA necessity, ↑ SABA concerns
