Common Sense Model Of Treatment Flashcards
Self regulation
Problem solving
Homeostasis
Self-regulation model/concept
Self regulation model/concept
- good health is ‘normal’
- illness is a problem
- we are motivated to solve problems
Interpretation
Coping
Appraisal
Representation of illness
Identity
Cause
Timeline
Consequences
Cure/control
Why are illness beliefs useful ?
Provide patients with a framework for coping with and understanding their illness:
– understand how different people make sense of different illnesses
– predict health behaviours
– change health behaviours
What does treatment of chronic disease require ?
Adherence which is vital for optimal treatment outcomes.
What do good treatment outcomes depend on ?
Good medical care
Self-management
Adherence
Integrating disease as optimally as possible.
Examples of some chronic diseases
Asthma
Diabetes
Kidney disease
Coronary heart disease
Cancer
HIV
Haemophilia
Symptoms and Causes of Asthma
Recurrent attacks of breathlessness, wheezing.
Swelling of living of bronchial tubes –> narrow the airways and reduces flow of air in/out of lungs
Statistics relating to asthma
- Leading preventable cause of morbidity, mortality & cost
- Affects 235 million people worldwide (WHO, 2016)
- Controlled not cured
Treatment of asthma
Most children/ young adults with asthma are treated with inhaled steroids.
- 1st step in preventative therapy
- Largely safe and effective
- But, nonadherence is high…
What is a self-management treatment in asthma ?
Steroid inhaler
Results of non-adherence in asthma
Poor asthma control
Decreased quality of life
Lost productivity
Increased healthcare utilisation
Risk of death
General results of non-adherence
Costly to provider and receiver
Wasted resources
Lack therapeutic benefit
Give some examples of factors resulting in non-adherence
Side effects of medications
Poor provider-patietn relationship
Missed appointments
Complexity of treatment
Presence of cognitive impairment
Factors affecting appropriate use of medication
Ability
Motivation
Beliefs
Treatment ability
Misunderstanding
Forgetting
Daily schedule difficulties
Physical impairment
Treatment motivation
Motivation to engage in & Maintain health-related behaviours
Treatment beliefs
Certain beliefs about medicines are common across locations, cultures, treatment categories (Horne, 1997)
e.g. beliefs that medicines are: - addictive
- produce long term effects …
2 categories of treatment beliefs
Necessity
Concerns
Necessity
Personal need for treatment
Concerns
Concerns about negative effects of treatment.
Can be concrete, abstract, relevant across range of disease states, cultures.
What factor determines adherence ?
Perceived necessity determines adherence…more than treatment efficacy
Assessment of treatment beliefs
Necessity-Concerns framework (BMQ - Beliefs about Medications Questionnaire)
- Specific necessity scale
- General harm & general overuse scale
BMQ
Beliefs about Medications Questionnaire
- valid and reliable
Treatment beliefs
Cost-benefit analyses
Personal evaluative summations
necessity beliefs vs concerns
COST-BENEFIT analyses determines ADHERENCE
Function of the CSM of treatment
Use of CSM helps us understand the process by which treatment beliefs influence adherence
Identity
Symptom experiences and expectations influence treatment necessity :
– severity of symptoms
– absence of symptoms (e.g. Hypertension)
Cause
Putative causes of illness may influence need for treatment options:
– changing diet vs taking medication…
Timeline and Consequences
Perceptions of illness duration and consequences may influence treatment necessity:
– perception of illness as cyclical vs chronic impacts on adherence to preventative medication (e.g. asthma)
Control
Beliefs about treatment necessity beliefs correlate with beliefs how the illness will be controlled:
– by treatment vs some other behavioural change….
Concerns
CONCERNS about treatment also comprise beliefs about illness representations.
Medication beliefs in asthma study
46% pts had doubts about need for preventative inhaler
43% reported concerns about adverse effects
1/3 pts thought doctors overprescribed medicines
17% pts thought medicines in general were harmful
MARS
Medication
Adherence
Report
Scale
