Health Behaviour and Adherence Flashcards
What is motivational interviewing
a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (mixed feelings)
What are the 4 steps of MI?
- Express empathy
- Develop discrepancy
- Roll with resistance
- Support self-efficacy
At what stages in the stages of change model is MI most effective?
‘precontemplative’ or ‘contemplative’
What is the aim of motivational interviewing?
Aims to elicit patient’s own arguments for change. It is a set of tools to help practitioners work with patients to change health behaviour e.g. drinking, diet, smoking
What is compliance?
theextenttowhichpatientbehaviourcoincideswithmedicaladvice
What is adherence?
Extent to which patient behaviour coincides with medical advice. Similar to compliance, normally used interchangeably
Explain concordance
Negotiation between the patient and doctor over treatment regimes
Implies the patient is active and in partnership with the doctor
Patient’s beliefs and priorities are respected and decisions are shared
Trying to be incorporated into clinical practice more and more
Draw Ley’s model of compliance
See notes
Why might concordance lead to better adherence
Patient is involved in, and has shared ownership of, decisions about treatment
Patients’ beliefs, expectations, lifestyle and priorities can be taken into account
Barriers to adherence e.g. practical or informational can be addressed
Promotes patient trust and satisfaction with care which makes adherence more likely
What is the impact of non-adherence?
Financial costs
Patients health worsens
Explain unintentional non-adherence
o Capacity and resource limitations e.g.
Individual constraints – memory, understanding, dexterity
Aspects of the environment – problems accessing prescriptions, competing demands, lack of social support
Explain intentional non-adherence
o Beliefs, attitudes and expectations e.g.
Beliefs about susceptibility/severity
Costs/benefits e.g. side effects
Other options e.g. complementary therapy
Poor doctor-patient relationship/lack of trust
Maintain a sense of control
Stigma/avoid labelling as a ‘patient’
What factors contribute to adherence?
- Illnessfactors
- Treatmentfactors
- Patientfactors
- Psychosocialfactors
- Healthcarefactors
Explain illness factors
• Symptoms -Adherencetendstobebetterwhenpatientsexperience symptoms
– Implicationsforasymptomaticconditions
• Severity-Withlessseriousdiseases(e.g.hypertension,arthritis)patientsinobjectivelypoorerhealtharemorelikelytobeadherentthanpatientsinbetterhealth.Withmoreseriousdiseases(e.g.cancer,HIV,heartfailure)patientsinpoorerhealtharesignificantlylesslikelytobeadherent.
Explain treatment factors
Preparation:treatmentsetting,waitingtime,timingofreferral,(in)convenience,poorreputation
Immediatecharacter:complexityofregimen,durationofregimen,degreeofbehaviourchange,(in)convenience,expense
Administration:supervisionbyHCPs(orparentswithchildren),continuityofcare
Consequences:physicalsideeffects,socialsideeffects,stigma
