C3

Question 1

what is the first reason for Non Adherence - Stress?

Answer 1

Poverty: Stress can arise due to poverty. Non adherence is worse in lower socioeconomic groups

Question 2

what is the second reason for Non Adherence - Stress?

Answer 2

Stress can be linked to chaotic lifestyle / disorganised: They may forget to take medication / advice

Question 3

what is the third reason for Non Adherence - Stress?

Answer 3

Stressed clients are often anxious: They may not pay full attention and ‘latch’ onto key words from doctor and therefore miss information. Or be too anxious to attend follow up appointments

Question 4

what is a strength of Reasons for Non Adherence - Stress

Answer 4

Research found: Hamidreza Roohafza et al (2016) 10,000 clients with diabetes and/or hypertension (high blood pressure). They found that the clients experiencing the highest levels of stress were non-adherent to medication or exercise advice.

Weakness of the study:
Lowers validity

Question 4

what is the fourth reason for Non Adherence - Stress?

Answer 4

Stress can impact memory: even if they understand they may forget. Between 40-80% medical advice is immediately forgotten and only about half is remembered.

Question 5

what is a weakness for Non Adherence - Stress?

Answer 5

long-term effects of stress on non-adherence are unclear

Question 6

what is a benefit of Rational Non-Adherence?

Answer 6

Reduce or eliminate the symptoms of an illness

Question 7

what is a cost of Rational Non-Adherence?

Answer 7

Side effects → some medicines can cause severe side effects that include: dizziness, stomach problems, sexual difficulties and memory problems

Question 8

what is a cost of Rational Non-Adherence?

Answer 8

Money problems → private healthcare patients are more likely to adhere because they don’t care about the costs, when people start paying for something their not used to paying for then they are more likely to non-adhere.

Question 9

what is a cost of Rational Non-Adherence?

Answer 9

Patient practitioner relationship → Practitioner centred (practitioner has all the power and treatment is non-negotiable), Patient centred (more personal)

Question 10

what is a cost of Rational Non-Adherence?

Answer 10

Lack of understanding → if the advice confuses the patient or if they patient does not understand the advice they will not do it

Question 11

what is a strength of Rational Non-Adherence?

Answer 11

Research in Spain found when older patients paid for their medication – adherence declined for expensive drugs but not cheaper ones. López-Valcárcel et al (2017) studied what happened in Spain when older patients had to start paying a share of medication costs in 2012. They found that adherence declined significantly for expensive drugs, but not for cheaper ones.

Question 12

what are two weaknesses of Rational Non-Adherence?

Answer 12

1)Also ignores emotional factors.

2)Health decisions are not often made rationally.

Question 13

what happens if the person is depressed?

Answer 13

Someone with learned helplessness might become depressed so the depression itself makes non adherence more likely. Non adherence makes depression worse & therefore reinforces learned helplessness, it’s a downwards spiral.

Question 14

what is the definition for Learned Helplessness?

Answer 14

If you are ill you may repeatedly face stressful situations that you can’t control, this means people may learn to be helpless in these situations. The outcome is even when there are opportunities to be in control they are not take

Question 15

what is a strength of Learned Helplessness?

Answer 15

Practical use:
Overcoming learned helplessness is a practical way to improve non-adherence. (e.g cognitive therapy can help individuals perceive links between behaviours and outcomes)

Question 16

what is a weakness of Learned Helplessness?

Answer 16

No research support

Question 17

what is meant by ‘lack of practical support’ when it comes to significant others?

Answer 17

Lack of practical support: no one to remind them to take medication or take them to appointments, show them how to access information

Question 18

what is meant by ‘lack of emotional support’ when it comes to significant others?

Answer 18

Lack of emotional support: adherence less likely if client lacks people who can help their mood, provide encouragement or support (shoulder to cry on)

Question 19

what is meant by ‘lack of practical support’ when it comes to health professionals?

Answer 19

Lack of practical support: health professions are experts on benefits of adherence, so lack of information from them can lead to non adherence

Question 20

what is meant by ‘lack of emotional support’ when it comes to health professionals?

Answer 20

Lack of emotional support: This is expected from client but there may be a gap in how much is given vs how much is expected. The key factor is how a client perceives the support. If they feel they can’t trust, of lack of communication they will perceive lack of emotional support.

Question 21

what is a strength of Lack Of Support?

Answer 21

Support for effectiveness:
People who live alone, are older and have cognitive impairment have lower adherence. Homeless people, people who live in unstable circumstances and people with mental health issues are at risk of non-adherence (wheeler et al 2014)

Question 22

what is a weakness of Lack Of Support?

Answer 22

Support on its own is not enough to improve adherence significantly

Question 23

how is marketing used for Improving adherence → health education and performance?

Answer 23

Marketing → advertisements that educates benefits of improving adherence in medical prescription are successful. It illustrates the needs of adherence to medical advice.

Question 24

how is modelling and literary skills used for Improving adherence → health education and performance?

Answer 24

Modelling and literary skills → provides a clear example of how medical advice is meant to be used and this is likely to help. The behaviours being modelled are by an authority which is likely to improve adherence as the client knows exactly what to do. Language that is used during appointments should be kept simple, to avoid misunderstandings which could damage adherence.

Question 25

how is client needs used for Improving adherence → health education and performance?

Answer 25

Client needs → if the information is given to the client through a way they prefer (like over the phone or a text), it can improve adherence because the client can access the information in the easiest way possible.

Question 26

how is patient education used for Improving adherence → health education and performance?

Answer 26

Patient education → the patient should fully understand the instructions given to them, this helps the patient improve their compliance and outcomes for their situation. The clearer someone understands the instructions the more comfortable they will be making them adhere.

Question 27

what is a strength of Improving adherence → health education and performance

Answer 27

Stephen Eraker et al (1984) → only 36% of clients understood the meaning of the phrase ‘every 6 hours’. Vague language should be avoided and instructions should be specific.
Research can play a useful role in identifying the barriers to adherence.

Question 27

how is rational adherence used for Improving adherence → health education and performance?

Answer 27

Rational adherence → some people will rationally choose to not adhere, this could be because they think they know better or may choose to not follow the advice because it may be inconvenient to them.

Question 28

what is a weakness of Improving adherence → health education and performance

Answer 28

Improving access without considering quality can backfire and lead to non-adherence.

Question 29

how is resistance used in Reduction of perceived threats?

Answer 29

Resistance → Clients resist following advice if they view it as threatening. Reducing their resistance can change the way they perceive the threat.

Question 30

how is understanding of needs used in Reduction of perceived threats?

Answer 30

Understanding of needs → This is where they perceive something as threatening if their needs aren’t met(like being accepted by others).

Question 31

how is safety and security used in Reduction of perceived threats?

Answer 31

Safety and security → If the client perceives the medical advice as dangerous, they are less likely to adhere, as this threatens their safety and security. If the needs are not met it can lead to fear.

Question 32

how is fear used in Reduction of perceived threats?

Answer 32

Fear → A client may be scared about thinking about there health in general so will avoid at all costs. It can be reduced by professionals helping them to address and recognise their fears directly.

Question 33

what is a strength of Reduction of perceived threats?

Answer 33

Offers a specific way to improve adherence- people don’t perceive enough threat from the illness itself causing them to not adhere.

Question 34

what is a weakness of Reduction of perceived threats?

Answer 34

Reducing threat perception may not change the behaviour: Interventions can help someone to judge the risks in a more accurate way (e.g. via side effects). However doesn’t necessarily mean that they will be more adherent

Question 35

what is one example of Lifestyle changes?

Answer 35

Reducing stress → Stress lowers motivation, so the client feels there is no point changing their behaviour. Interventions should help client manage stress first.

Question 36

what is another example of Lifestyle changes?

Answer 36

Emotional resilience → Individuals who are emotionally resilient ‘bounce back’ quickly from setbacks. They are more likely to adhere to medical advice even when it may seem easier to give up.

Question 37

what is a fourth example of Lifestyle changes?

Answer 37

Insight into own behaviour → Sometimes a person’s ingrained habits prevents them from adhering.
One way to overcome this is to help the person become aware of their habits and recognise them as ‘mindless’.
They gain insight into their own behaviour, identifying the reasons why they fail to make lifestyle changes.

Question 37

what is a third example of Lifestyle changes?

Answer 37

Improving self-esteem and self-confidence → Some people lack confidence in changing their behaviour and failure makes them feel bad about themselves ( low self esteem ) and lose confidence. Interventions should boost self-esteem and self-confidence

Question 38

what is a fifth example of Lifestyle changes?

Answer 38

Improving outlook on life → Optimistic people have a positive outlook. They are hopeful and think about the good things that could happen without dwelling on past failures. They adhere to medical advice because they focus on positive changes adherence can bring

Question 39

what is a strength of Lifestyle changes?

Answer 39

Several lifestyle factors exist for interventions to target. For example, if the client is more optimistic, they may also experience less stress and become more resilient and confident

Question 40

what is a weakness of Lifestyle changes?

Answer 40

There are no supporting research studies that say that lifestyle changes can improve adherence.

Question 41

what is Provision Of Incentives?

Answer 41

Provision of Incentives:

Incentive provisions means providing rewards for the purpose of encouraging people to change their behaviour. Incentives - a thing that motivates or encourages someone to do something.

Question 42

what is one example Behavioural changes?

Answer 42

Persuasive health reminders:

Persuasive texts→ reminds clients of their treatment goals

Question 43

what is a second example Behavioural changes?

Answer 43

Persuasive health reminders:

Self tracking→ use
technology e.g. phones to count steps or track physiological indicators

Question 44

what is a third example Behavioural changes?

Answer 44

Persuasive health reminders:

Progress monitoring→ also provided by app so clients can see progress.

Question 45

what is social prescribing?

Answer 45

Social prescribing:
Health professionals may encourage clients to consider non medical options e.g. volunteering or joining a support group. A depressed client may also be lonely so joining a group may be beneficial to them. Social prescribing is useful for client who have complex or long-term needs.

Question 46

what is a strength of Provision of Incentives?

Answer 46

Smokers give money to quit were three times more likely to stop smoking compared to smokers only given information (Volpp et al)

The control group received no incentives. Quitting for 6 months earned you $250, quitting for 12 months $400. The treatment group had 3 times the success rate of the control (14.7% gave up smoking vs 5%), even after financial incentives were discontinued after 12 months (9.4% vs 3.6%).
Money is a positive reinforcer of desired behaviour.

Question 47

what is another strength of Provision of Incentives?

Answer 47

Highly motivates people

Question 48

what is a weakness of Provision of Incentives?

Answer 48

Only a short term solution

Question 49

what is a strength of Persuasive health reminders?

Answer 49

The use of technology in self tracking and progress monitoring (‘E-coaching’) means that apps can be tailored to a specific clients needs - more personalised

Question 50

what is a weakness of Persuasive health reminders?

Answer 50

self tracking may be ineffective for some people as they may cause anxiety and obsessiveness

Question 51

what is a strength of Social prescribing?

Answer 51

There are practical applications such as eCoaching. This uses to technology to support healthy behavioural change. Lentferink et al (2017) found eCoaching proved adherence in several groups of people especially when it was personalised.

Question 52

what is a weakness of Social prescribing?

Answer 52

Most studies of social prescribing have methodological problems, e.g. no control groups, no analysis and small sample sizes