Adherence to Treatment

Question 1

what is the definition of compliance?

Answer 1

acting according to a request or a demand.

Question 2

what is the definition of adherence?

Answer 2

“to stick fast to” e.g. treatment regimen of drugs.

Question 3

what are the direct measurements of (non)adherence?

Answer 3

o Directly observed therapy.

o Measurements of blood levels of medicine or biological marker.

Question 4

what are the indirect measurements of (non)adherence?

Answer 4

o	Patient self-reporting and patient diaries.
o	Pill counts.
o	Rates of prescription refills.
o	Electronic medication monitors.
o	Measurement of physiologic markers.

Question 5

what are some consequences of non-adherence?

Answer 5

o Increased hospital admission (1 in 10 due to non-adherence)
o Rejection of transplants.
o Occurrence of complications.
o Increased mortality
o Poorer health outcomes therefore increased healthcare costs

Question 6

what are the causes of non-adherence? treatment factors

Answer 6

o	Physical aspects -  e.g. the packaging of the drugs (easy access).
o	Complexity.
o	Duration.
o	Cost.
o	Side effects.

Question 7

what are the causes of non-adherence? presentation factors

Answer 7

o	Volume of information.
o	Order.
o	Stressing import.
o	Specificity.
o	Mode of presentation.
o	Follow-up.

Question 8

what are the two types of non-adherence?

Answer 8

intentional and unintentional

Question 9

what is intentional non-adherence?

Answer 9

know HOW but RELUCTANT – treatment doesn’t make sense, worries or concerns, cultural beliefs about disease.

Question 10

what is unintentional non-adherence?

Answer 10

doesn’t know HOW – poor HCP-patient communication, low patient satisfaction, cognitive difficulties, financial barriers.

Question 11

what does the COM-B model describe?

Answer 11

describes factors and interactions relating to adherence.

Capability, motivation and opportunity feeding into adherence.

Question 12

what are some reasons for non-compliance?

Answer 12

concerns about treatment
beliefs about illness
cost of therapy
necessity of therapy perceived drug efficacy.

Question 13

what influence health beliefs?

Answer 13

o Identity – what the person identifies the illness as.
o Casual beliefs (of drugs).	
o Timeline (of taking drugs).
o Consequences (of taking drugs).
o Cure/control (can the drug do this).

COM-B influences non-adherence (as a result of health belief) and health behaviour in general

Question 14

how can adherence be improved?

Answer 14

1) ask about patient’s adherence
2) consultation to anticipate and plan; identify beliefs and aim to modify them
3) involve significant others; widen the network; use assistive technologies e.g reminders
4) simplify the regime and packaging
5) communication and presentation e.g written information
6) improve understanding of illness and treatment:
- -> provide rationale for necessity
- -> elicit and address CONCERNS with the treatment
- -> agree a practical plan and identify any barriers to such: when and where

Question 15

what is the “serial position effect”

Answer 15

information said at the beginning and end of the consultation is better recalled than the rest of the information.

Question 16

what factors affect recall of information?

Answer 16

anxiety, medical knowledge and memory impairment.

Question 17

what cognitive techniques can be used in improving adherence?

Answer 17

role-play
goal-setting
stepped behaviour change
rewards
relapse prevention
stress management, desensitisation to stressful stimuli
improving self-efficacy.

Question 18

general improvement points for adherence

Answer 18

• Improve regime
• Identify/modify beliefs.
• Wider network (social support)
• Improve interactions.
• Involve significant others.
• planning and repeating

Question 19

what sort of information would patients prefer for. recall?

Answer 19

written down

increases adherence
o Flesch formula – based on average sentence length and number of syllables per 100 word

Question 20

COM-B components

Answer 20

Capacity Opportunity Motivation–> Behaviour

• capacity= ability to engage in health behaviour
• opportunity= all the factors that lie outside the individuals control affecting the execution of behaviour
• motivation = brain processes that energies and direct behaviours

Question 21

what two factors make up Capacity?

Answer 21

psychological

physical

Question 22

what two factors make up Opportunity?

Answer 22

physical

social

Question 23

what two factors make up Motivation?

Answer 23

Belief (reflection)

Habits (automatic)