Health Psych Adherence1

Question 1

• “The extent to which a person’s behavior (in
terms of taking medications, following diets, or
executing lifestyle changes) coincides with
medical or health advice” (Haynes, 1979)
• Also known as compliance

Answer 1

adherence

Question 2

– When patients do not adopt the behaviors and treatments
their providers recommend
– Estimates range from 15% to 93%
– Average is 24.8%

Answer 2

nonadherence

Question 3

“intelligent nonadherence”

– Modifying and/or supplementing a prescribed treatment regimen

Answer 3

creative nonadherence

Question 4

greatest adherence rates in

Answer 4

HIV, arthritis, gastrointestinal disorders, cancer

Question 5

Measuring adherence – Turk and Meichenbaum

(1991) Study

Answer 5

• Use of Theophylline: Drug used for chronic
obstructive pulmonary disease (COPD)
– Physician reports: 78% of the COPD patients were using the drug
– Patient charts: 62% of the COPD patients were using the drug
– Videotape observations: 69% of the COPD patients were using the drug
– Patient reports: 59% of the COPD patients said they were on the drug

Question 6

How do we measure adherence?

Answer 6

• Ask the practitioner
– Poorest choice
• Ask the patient
– More valid but patients may lie or may not know
• Ask other people
– May be physically impossible
– May create an artificial situation and increase
compliance
• Monitor medication usage
-examine biochemical evidence
-USE COMBO OF THESE(more accurate but costly)

Question 7

1. disease severity X
2. pain and perceived severity >
3. side effects <
4. complexity of treatment

Answer 7

factors predicting adherence for disease and treatment

Question 8

1. age - curvilinear dropping wit older age and low among child/adole
2. gender -few diff
3. personality patterns
4. emotional factors
5. personal beliefs - self efficacy important

Answer 8

personal factors predictng adherence

Question 9

economic, social support (important predictor), cultural norms (diff treatments)

Answer 9

environmental factors predicting adherence

Question 10

ethnicity, patient (low ses or elderly), disease, sexism

Answer 10

stereotypes of patients

Question 11

physicians attribute nonadherence to:

Answer 11

– Patients’ uncooperative personalities
– Patients’ ignorance
– Patients’ lack of motivation
– Patients’ forgetfulness

Question 12

greatest cause of nonadherence is ….

Answer 12

poor communication

Question 13

patients focus on ___ and ____

Answer 13

pain and interference with activities

Question 14

providers are concerned with ____ ,___, and ___

Answer 14

underlying illness, severity, treatment

Question 15

• 1/3 of patients cannot repeat their diagnosis
within minutes of discussing it
• Anxiety impairs retention of information
• 40% of patients aged 50+ have difficulty
understanding prescription information

Answer 15

Examples of Outcomes of Faulty Communication

Question 16

Problem: Not Listening

• Beckman and Frankel (1984) Study

Answer 16

– 74 office visits studied
– 23% of the cases patients finished explanations
– 18 second average before the physician interrupted
the patient
– Note: Physicians KNEW they were being recorded

Question 17

Problem: Use of Jargon
• Patients don’t understand many terms that
providers use
• Jargon may be used

Answer 17

– To keep the patient from asking too many questions
– To keep the patient from discovering that the provider
is uncertain about the problem
– As a carryover from technical training

Question 18

• Physician’s role is changing

Answer 18

More egalitarian attitudes

– Less dominance and authority

Question 19

training patients questions to ask are:

Answer 19

1. during this visit i would like to know..
2. the reason i am seeing the dr today is….
3. anotehr concern i want to discuss is

Question 20

• Optimistic bias or unrealistic optimism
• Complexity of treatment doesn’t fit lifestyle
• Symptoms disappear
• Symptoms don’t get better or get worse
• Healthy behaviors are difficult to adhere to
• Financial and practical problems

Answer 20

other barriers to adherence

Question 21

Vivid communications
• Expert communicator
• Strong arguments at 
beginning and end
• Short, direct messages
• Explicit conclusions
• Avoid VERY extreme 
messages and avoid 
eliciting too much fear
• Illness Detection: 
Emphasize the 
problems that may 
occur if it isn’t done
• Health Promotion: 
Emphasize the 
benefits to be gained
• Non-receptive 
audiences need to 
hear both sides

Answer 21

educational strategy to improve adherence

Question 22

educational strategies : message framing

Answer 22

• Messages that emphasize potential
problems
– Work better for behaviors that have uncertain
outcomes
• Messages that stress benefits
– Work better for behaviors with certain
outcomes

Question 23

• heatlhcare institution interventions(postcard reminders, reducing time before service)
• treatment presentation interventions(write down regimen and test patient for understanding)
• skills training
• probing for barriers

Answer 23

improving adherence

Question 24

factors predict adherence?

Stereotypes of Patients

Answer 24

ethnicity, patient SES, disease, sexism

Question 25

personal factors that predict adherence are

Answer 25

age, gender, personality patters, emotional factors, personal beliefs

Question 26

environmental factors that predict adherence

Answer 26

economic factors, social support, cultural norms

Question 27

what erodes communication? the setting by:

Answer 27

• The medical office is an unlikely setting for
effective communication
• The person who is ill
– Must answer questions and be poked and prodded
while in pain or ill
– May feel anxious or embarrassed, reducing effective
communication
• The provider
– Has to figure out significant information quickly while
other patients are waiting