Health Psych Adherence1 Flashcards
• “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
adherence
– When patients do not adopt the behaviors and treatments
their providers recommend
– Estimates range from 15% to 93%
– Average is 24.8%
nonadherence
“intelligent nonadherence”
– Modifying and/or supplementing a prescribed treatment regimen
creative nonadherence
greatest adherence rates in
HIV, arthritis, gastrointestinal disorders, cancer
Measuring adherence – Turk and Meichenbaum
(1991) Study
• 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
How do we measure adherence?
• 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)
- disease severity X
- pain and perceived severity >
- side effects <
- complexity of treatment
factors predicting adherence for disease and treatment
- age - curvilinear dropping wit older age and low among child/adole
- gender -few diff
- personality patterns
- emotional factors
- personal beliefs - self efficacy important
personal factors predictng adherence
economic, social support (important predictor), cultural norms (diff treatments)
environmental factors predicting adherence
ethnicity, patient (low ses or elderly), disease, sexism
stereotypes of patients
physicians attribute nonadherence to:
– Patients’ uncooperative personalities
– Patients’ ignorance
– Patients’ lack of motivation
– Patients’ forgetfulness
greatest cause of nonadherence is ….
poor communication
patients focus on ___ and ____
pain and interference with activities
providers are concerned with ____ ,___, and ___
underlying illness, severity, treatment
• 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
Examples of Outcomes of Faulty Communication
Problem: Not Listening
• Beckman and Frankel (1984) Study
– 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
Problem: Use of Jargon
• Patients don’t understand many terms that
providers use
• Jargon may be used
– 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
• Physician’s role is changing
More egalitarian attitudes
– Less dominance and authority
training patients questions to ask are:
- during this visit i would like to know..
- the reason i am seeing the dr today is….
- anotehr concern i want to discuss is
- 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
other barriers to adherence
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
educational strategy to improve adherence
educational strategies : message framing
• Messages that emphasize potential
problems
– Work better for behaviors that have uncertain
outcomes
• Messages that stress benefits
– Work better for behaviors with certain
outcomes
- 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
improving adherence
factors predict adherence?
Stereotypes of Patients
ethnicity, patient SES, disease, sexism
personal factors that predict adherence are
age, gender, personality patters, emotional factors, personal beliefs
environmental factors that predict adherence
economic factors, social support, cultural norms
what erodes communication? the setting by:
• 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
