Adherence and Consultation

Question 1

At each stage of dealing with an illness, there are factors which interfere with this process- such as:

Answer 1

• “Am I ill? Is that a symptom?”
• “Is it worth bothering a doctor about?”
• “Will the doctor see me?”
• “I’m just getting old – I’m expected to have health problems!”
• “There are others more needy than me; I’m not that ill”

Question 2

Initiating consultation is a ——— decision

Answer 2

Initiating consultation is a behavioural decision

Question 3

Outline the ‘integrated behaviour change model for physical activity’ by Hagger & Chatzisarantis (2014).

Answer 3

Question 4

Give examples of patterns of consultation behaviours

Answer 4

• Variation between individuals in consultation behaviour
• Some consult for minor ailments
• Others rarely consult: the “Clinical Iceberg” effect
• Doctors only see the tip of the iceberg
• Structural factors are also important
• Inability to get a GP appointment; postcode lottery

Question 5

What were the general findings from the Cowling et al. (2014). Access to general practice and visits to A&E from National Patient Survey data

Answer 5

• 11% increase in “unplanned” attendances at A&E, 2008/9 – 2012/13
• 5.77 million A&E attendances were the result of patient not being able to access general practice

Question 6

Why is early consultation important

Answer 6

• Early diagnosis helps with uncertainty (of symptoms)
• Better management of care (planning); avoidance of risks (vehicle accidents, medication errors)
  
  • And treatment
• Early access to medical and non-medical (lifestyle interventions) treatment
• Alzheimer’s Disease International (2011): >50% cases are not recognised in primary care (GPs)

Question 7

What % of new cancer diagnoses are made following A&E visit (i.e., quite late)

Answer 7

25%

Question 8

What are the implications of: 25% of cancer diagnosis being made in A&E and 10% of people with cancer see GP >5 times before getting a diagnosis

Answer 8

• Not everyone takes up screening opportunities
• Doctors may be ill-prepared for identifying some symptoms
• Potentially more severe symptoms and progression of disease = worse outcomes

Question 9

The patient has the disease and the test correctly identifies it

Answer 9

True Positive

Question 10

The patient does not have the disease and the test correctly identifies it

Answer 10

True negative

Question 11

The patient does not have the disease but the test says they do

Answer 11

False positive

Question 12

The patient has the disease but the test says they do not

Answer 12

False negative

Question 13

What is an individual’s perception of a symptom based upon?

Answer 13

• Personality factors
• Demographics (age, gender, SES, ethnicity etc.)
• Mood / cognition

Question 14

The social contexts affects our perceptions of ‘symptoms’

Describe what Levine and Reicher (1996) found: PE vs. FEMALE identity and perceptions of facial scars

Answer 14

More worried about facial scars when social identity was shifted to female from course studied in undergraduates

Question 15

Describe the findings of Haslam et al. (2012)- affect of self-categorising as old vs young

Answer 15

Question 16

Why might a elf-categorization as “older” led to poorer performance on all tests

Answer 16

A “stereotype threat” effect

• Effect interacted with aging expectations
• Those expecting general decline reported poorer performance on cognitive ability tests (and met criteria for detecting dementia)
• Those expecting memory decline performed worse on memory tests
• Highlights the importance of social identity (self-categorization) in symptom perception (and “role” performance)

Question 17

What did Porter et al. (2004) find regardining illness consulation

Answer 17

• 50-75% of UK population experience ill-health symptoms over a 2-week period
• But only 1/3 of these consult a GP
• Others self-medicate, or live with symptoms (which may or may not pass)
• Illness cognitions are an important consideration

Question 18

What are the 5 steps of an illness cognition

Answer 18

1. Identification/classification (what is it?)
2. Timeline (how long will it last?)
3. Causes (what caused it?)
4. Consequences (how will is affect my life?)
5. Controllability (can I manage myself or do I need help?)

Question 19

What factors could interfere with consulation

Answer 19

• Whether seeking help will get in the way of work / disrupt normal life
• Whether seeking help will get in the way of social life
• Anticipation of costs/benefits of going to the doctor
• Social pressure not to seek help – public health campaigns
• Past experiences of symptoms

Question 20

What is the problem associated with social stigma

Answer 20

• Some illnesses, especially mental health, are routinely stigmatised
  
  • Expecting stigma can inhibit help-seeking
  • Encourages patients to hide symptoms
  • 1/3 of patients with depression never seek help
• A threat to “healthy” identity–> denial of symptoms (Farmer et al., 2012)

Question 21

What does this graph describe

Answer 21

Decision to consult not always straightforward and takes time.

We tend to seek help when symptoms are at their peak – and may be in decline

Question 22

Describe the Stanley Milgram (1963) experiment

Answer 22

• “Learning experiment”: participant (always the teacher) and a learner (confederate)
  
  • Teacher had to ask learner questions
  • “Electric shock” administered for each incorrect answer
  • Intensity of shock increased with each administration
  • Maximum shock = 450 volts
• None of the participants said they would administer a fatal shock
  
  • 65% of participants obeyed the teacher (gave fatal 450v shock)
• CONCLUSION: people do a lot when compelled to do so, especially by authority figures

Question 23

What % of prescriptions are adhered to?

Answer 23

• 920 million prescriptions in 2010 (2.5M per day)
• Adherence is low: 40-55% (Ley, 1997)
  
  • Accounts for >10% of hospital admissions

Question 24

Give 2 types of compliance failure

Answer 24

• Delay in (re-)seeking help
• Failure to follow-up (breaking appointments)
• Failure to follow Dr’s instructions
• Incorrect dose or at wrong times
• Non-completion of course

Question 25

Why is social identity important

Answer 25

• Group membership (and identities) give us meaning
• A “lens” for understanding the world
• Strong set of norms guiding cognition and behaviour

Question 26

Define social identity

Answer 26

The group dynamics that shape other intergroup interactions also influence clinical interactions – and outcomes

Question 27

How can social identity affect adherence

Answer 27

• Social identity may affect understanding, interpretation, memory for advice, and patient satisfaction (with consultation)
  
  • this may impact adherence

Question 28

How might we measure adherence?

Answer 28

• Accelerometers
• Diaries/log books
• Attendance at rehab classes
• Observation
• Self-report questionnaires