Chapter 4

Question 1

How do researchers know the percentage of patients who fail to adhere to practitioners’ recommendations?

Answer 1

adherence rates are not known with certainty, but researchers use techniques that yield a great deal of information about nonadherenc

Question 2

six basic methods of measuring patient adherence

Answer 2

1. ask the practitioner
2. ask the patient
3. ask other people
4. monitor medication usage
5. examine bio-chemical evidence
6. use a combination of these procedures.

Question 3

Adherence

Answer 3

A patient’s ability and willingness to follow recommended health practices.

Question 4

How common are failures of adherence?

Answer 4

adherence rates were higher when treatment was meant to cure rather than to prevent a disease. However, adherence was lower for medication taken for a chronic condition over a long period; adherence was around 50% for either prevention or cure.

Question 5

Optimistic bias

Answer 5

The belief that other people, but not oneself, will develop
a disease, have an accident, or experience other negative events.

Question 6

The three leading causes of death in the United States— _______, ______, and _________ —are all affected by unhealthy lifestyle choices such as smok- ing cigarettes, abusing alcohol, not eating properly, and not exercising regularly.

Answer 6

cardiovascular disease, cancer, and chronic obstructive lung disease

Question 7

Who adheres and who does not?

Answer 7

The factors that predict adherence include personal characteristics and environmental factors that are difficult or impossible to change, such as age or socioeconomic factors.

Question 8

the first set of factors that predict adherence

Answer 8

severity of the disease; treatment characteristics, including side effects and complexity of the treatment; personal characteristics, such as age, gender, and personality; and environmental factors such as social support, income, and cultural norms

Question 9

T/F: women are more likely to adhere in comparison to men

Answer 9

False, overall, researchers find few differences in the adherence rates of women and men, but some differences exist in following specific recommendations.

Question 10

T/F: the evidence suggests that nonadherence is not specific to a given situation but is a global personality trait

Answer 10

False, the evidence suggests that nonadherence is not a global personality trait but is specific to a given situation

Question 11

Do anxiety and depression reduce adherence rates?

Answer 11

The risk of nonadherence is three times greater in depressed patients than in those who are not depressed. More recent studies show that depression relates to lower adherence among people managing chronic illnesses, such as diabetes and HIV

Question 12

Conscientiousness

Answer 12

A personality trait marked by a tendency to be planful and goal-oriented, to delay gratification, and to follow norms and rules

Question 13

______ _______ children and adolescents have a lower rate of adherence to a diabetes regimen, but this difference disappears after controlling for income differences

Answer 13

Hispanic American

Question 14

Social support

Answer 14

Both tangible and intangible support a person receives
from other people

Question 15

Physicians tend to have stereotypi- cal and negative attitudes toward ______ ______ and _____- ______ ______ -______ patients, including pessimistic beliefs about their rates of adherence.

Answer 15

African American; low- and middle-income

Question 16

To gain a fuller understanding of adherence, researchers must study the _____ ______ of factors that affect adherence.

Answer 16

mutual influence

Question 17

Continuum theories

Answer 17

Theories that explain adherence with a single set of factors that should apply equally to all people.

Question 18

Four beliefs of the the health belief model that should combine to predict health-related behaviors:

Answer 18

1. perceived susceptibility to disease or disability
2. perceived severity of the disease or disability
3. perceived benefits of health-enhancing behaviors
4. perceived barriers to health-enhancing behaviors, including financial costs.

Question 19

Reciprocal determinism

Answer 19

Bandura’s model that includes environment, behavior, and person as mutually interacting factors.

Question 20

Self-efficacy

Answer 20

The belief that one is capable of performing the behaviors that will produce desired outcomes in any particular situation.

Question 21

The four ways Bandura suggested that self-efficacy can be acquired, enhanced, or decreased

Answer 21

1. performance, or enacting a behavior such as successfully resisting cigarette cravings
2. vicarious experience, or seeing another person with similar skills perform a behavior
3. verbal persuasion, or listening to the encouraging words of a trusted person
4. physiological arousal states, such as feelings of anxiety or stress, which ordinarily decrease self-efficacy.

Question 22

Outcome expectations

Answer 22

The beliefs that carrying out a specific behavior will lead to valued outcomes

Question 23

theory of planned behavior

Answer 23

systematic use of information when deciding how to behave; they think about the outcome of their actions before making a decision to engage in a particular behavior.

Question 24

The three factors that shape intentions

Answer 24

1. one’s attitude toward the behavior.
2. one’s perception of how much control exists over one’s behavior
3. one’s perception of the social pressure to perform or not perform the action—that is, one’s subjective norm.

Question 25

Positive reinforcement

Answer 25

Adding a positively valued stimulus to a situation, thereby strengthening the behavior it follows.

Question 26

Negative reinforcement

Answer 26

Removing an unpleasant or negatively valued stimulus from a situation, thereby strengthening the behavior that precedes this removal.

Question 27

Punishment

Answer 27

The presentation of an aversive stimulus or the removal of a positive one. Punishment sometimes, but not always, weakens a response.

Question 28

Stage theories

Answer 28

Theories that propose that people pass through discrete
stages as they attempt to change a health behavior. Stage theories propose that different factors become important at different times, depending on a person’s stage.

Question 29

five spiraling stages in making changes in behavior in the transtheoretical model

Answer 29

precontemplation, contemplation, preparation, action, and maintenance.

Question 30

Does the transtheoretical model apply equally to different problem behaviors?

Answer 30

the transtheoretical model worked best for understanding smoking cessation compared with many other health behaviors. the transtheoretical model has not been as successful in predicting adherence to other behaviors such as special diets, exercise, or condom use.

Question 31

Motivational phase

Answer 31

In the health action process approach, the stage in which a person develops an intention to pursue a health-related goal.

Question 32

Volitional phase

Answer 32

In the health action process approach, the stage in
which a person pursues a health-related goal

Question 33

Do stage theories help a practitioner predict and change behavior?

Answer 33

One of the strengths of stage models is that they recognize the benefit of tailoring interventions to a person’s stage of behavior change.

Question 34

Behavioral willingness

Answer 34

A person’s motivation in a given situation to engage in a risky behavior, often as a reaction to social and situational pressures.

Question 35

Implementational intentions

Answer 35

Detailed plans that link a specific situation with a goal that a person wants to achieve

Question 36

Two strategies for improving adherence

Answer 36

educational and behavioral strategies.

Question 37

Educational procedures

Answer 37

those that impart information, sometimes in an emotion-arousing manner designed to frighten the nonadherent patient into becoming adherent.

Question 38

Behavioral strategies

Answer 38

focus more directly on changing the behaviors involved in compliance.

Question 39

Motivational interviewing

Answer 39

A therapeutic approach that originated within substance abuse treatment that attempts to change a client’s motivation and prepares the client to enact changes in behavior.

Question 40

four categories of behav- ioral strategies for improving adherence by Robin DiMatteo and Dante DiNicola

Answer 40

1. various prompts can be used to remind patients to initiate health-enhancing behaviors.
2. tailoring the regimen, which involves fitting the treatment to habits and routines in the patient’s daily life
3. graduated regimen implementation that reinforces successive approximations to the desired behavior.
4. a contingency contract (or behavioral contract). an agreement, usually written, between patients and health care professionals that provides for some kind of reward to patients contingent on their achieving compliance.

Question 41

What is adherence, how is it measured, and how frequently does it occur?

Answer 41

Adherence is the extent to which a person’s behavior coincides with appropriate medical and health advice. Researchers can measure adherence in at least six ways: (1) ask the practitioner, (2) ask the patient, (3) ask other people, (4) monitor use of medicine, (5) examine biochemical evidence, and (6) use a combination of these procedures. an analysis of more than 500 studies revealed that the average rate of nonadherence is around 25%, with people on medication regimens more adherent than those who must change health-related behaviors.

Question 42

What factors predict adherence?

Answer 42

No one factor accounts for adherence, so researchers must consider a combination of factors, such as:

unpleasant or painful side effects of medication, age, emotional factors such as stress, anxiety, and depression, beliefs in a regimen’s ineffectiveness, income, culture

Question 43

What are continuum theories of health behavior, and how do they explain adherence?

Answer 43

Continuum theories of health behavior identify variables that should predict the likelihood a person will adhere to a healthy behavior. Continuum theories propose that the variables should predict adherence in the same manner for all individuals.

Question 44

What are stage theories of health behavior, and how do they explain adherence?

Answer 44

Stage theories propose that people progress through discrete stages in the process of changing their behavior, and that different variables will be important depending on what stage a person is in. All theories—continuum and stage theories—are useful for understanding adherence but limited by their omission of various social, economic, ethnic, and other demographic factors that also affect people’s health behavior.

Question 45

What is the intention–behavior gap, and what factors predict whether intentions are translated into behavior?

Answer 45

The intention–behavior gap refers to the fact that intentions are imperfect predictors of adherence. Behavioral willingness refers to a person’s motivation at a given moment to engage in a risky behavior and is driven largely by social pressures in a specific situation.

Question 46

How can adherence be improved?

Answer 46

Educational methods may increase patients’ knowledge, but behavioral approaches are better at enhancing adherence. Strategies for enhancing adherence fall into four approaches:
1. providing prompts
2. tailoring the regimen
3. implementing the regimen gradually
4. making a contingency contract.