Help and Adherence

Question 1

How many people with symptoms actually seek help?

Answer 1

-1/3 of people

Question 2

What do others do if they don’t seek help and why?

Answer 2

• Self-medicate
• Seek alternative therapies
• They are desperate or don’t trust the healthcare system

Question 3

Unworried and unwell

Answer 3

• People who need care but don’t consult

- Actually sick but don’t think it is something to worry about

Question 4

Worried well

Answer 4

• People who don’t need care and are consultuing

- People who seek help for everything

Question 5

What are the components of illness representations? (6)

Answer 5

• Stress and coping responses
• Identity/Label of threat
• Cause (causal mechanism)
• Consequences (perceptions of threat)
• Timeline (acute, chronic, cyclical)
• Control/Cure (Will meds help? Personality?)

Question 6

How does personality relate to control/cure?

Answer 6

• Those high in conscientiousness = stronger belief in effectiveness of treatment = seek help
• Those high in neuroticism = believe the label is serious but do not believe in effectiveness = do not seek help

Question 7

What is illness coherence?

Answer 7

-What are my understandings of this symptom/disease I have?

Question 8

What do illness representations do?

Answer 8

• Help to find out who will seek help

- Are they not seeking help because they are so scared or don’t think it is a big deal?

Question 9

How does social influence affect health-related behaviour?

Answer 9

• Mass media can influence what is thought to be normal
• Advice from others
• Organization of health care systems (ease of access)
• Having opportunity (i.e. time away from work, no childcare)
• Not interfering with other activities (i.e. having time, giving up fun time)
• People won’t seek help if they think it is an inconvenience, or if there is a legitimate barrier

Question 10

What is compliance?

Answer 10

• The overt behaviour of one person that conforms to the wishes or the behaviours of others
• Obedience to a request whether or not they believe in what they are doing
• As soon as social pressure/force leaves = they quit
• We don’t want this!

Question 11

What is adherence?

Answer 11

• A more active, voluntary, collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a desired preventative or therapeutic result
• Act on consensually agreed-upon plan
• Had part in choice and designing doing treatment planning and implementation
• Behave according to, follow in detail
• Believes in what they are doing and doing the behaviour because they WANT to; accepts the importance of the behaviour
• If you adhere because you believe and want to = extends length of the behaviour

Question 12

What is the challenge with adherence?

Answer 12

-The healthcare system operates by putting limits on a time a person can spend with the physician, therefore physicians rush and person may not have time to ask questions they have; therefore harder time in believing the benefits

Question 13

What is non-adherence?

Answer 13

• The failure to fully comply with treatment recommendations for modification of a health habit or an illness state
• Negative connotation
• Not following what you are asked to do

Question 14

What is creative non-adherence?

Answer 14

• The modification or supplementation of a prescribed treatment regimen on the basis of privately held theories about the disorder or its treatment
• tweak what you are prescribed because you have your own ideas
• Not adhering to what doctor says because of aunt’s loyalty to juicing

Question 15

What are reasons people use creative non-adherence?

Answer 15

• Person can’t afford the treatment therefore tries to make it last as long as possible or shares with family
• Confusion or concerns about the treatment (not fully understanding)
• Supplementation of treatment because the person things it will help (i.e. detox)

Question 16

What measurement tool is commonly used to measure adherence?

Answer 16

-Questionnaires

Question 17

How are the questions on the questionnaire tool?

Answer 17

• Reverse scored questions (so people actually read them)

- Ask about behaviour change constructs (i.e. self-efficacy: “I found it easy to do the things my doctor suggested..”)

Question 18

What is the rate of non-adherence with medical advice? People who do not follow short and long term plans respectively?

Answer 18

• 50%
• 38%
• 43%

Question 19

People who don’t stick to recommended healthy lifestyles?

Answer 19

-75%

Question 20

Dietary regimen compliance?

Answer 20

-30-70%

Question 21

What happens with exercise program frequencies?

Answer 21

-50% drop out within 6 months

Question 22

What type of data is better to get accurate reports?

Answer 22

• Self-reported data versus pedometer data

- Actual data reports less activity than what people report they do!

Question 23

How do symptoms influence adherence?

Answer 23

• Persistence (if given a treatment and symptoms stay, will you stay on it?)
• Perceived as serious (serious = more likely to adhere)
• Perceived as curable (will I get better if I adhere?)
• Interference with other goals/activities

Question 24

How do treatments influence adherence?

Answer 24

• Perceived to be effective (do I believe it is effective?)
• Don’t interfere with other goals/activities (timing issues when you have to take meds?)
• Not complex or difficult to adhere to
• Short term (=better)

Question 25

What personal factors influence adherence?

Answer 25

• Characteristics of the target person
• Characteristics of the person giving advice (do they care about me?)
• Normative influences (subjective/injunctive norms and descriptive norms)

Question 26

Subjective norms

Answer 26

• Social pressure

- Do people who care about me want to do this?

Question 27

Descriptive norms

Answer 27

• What do people like me do?

- If other people who have the same condition are doing this = easier to adhere to it

Question 28

What is concordance?

Answer 28

• The collaboration between patients and healthcare professionals
• The idea dream
• Patient centred
• Patient can ask as many questions
• Needs time, expensive, and labor intensive
• Tailor the treatment to the patient’s lifestyle, not the other way around
• Beyond adherence

Question 29

What are the antecedents of adherence? (4)

Answer 29

• Understanding
• Memory
• Satisfaction
• Self-efficacy

Question 30

How does understanding antecedents?

Answer 30

• Knowledge is necessary but not sufficient
• Does the person understand what is being asked of them. the purpose, potential outcome?
• Do they understand the what and why they are being asked?

Question 31

How does memory antecedents?

Answer 31

• Do you actually remember what you have been asked to do?

- Event-based recall is more effective than time based (linking to an actual event e.g. take pills with dinner)

Question 32

How does satisfaction antecedents?

Answer 32

• Easier to do something if you are happy about it

- Feeling satisfied with treatment = more likely to stick and adhere to it

Question 33

How does self-efficacy antecede?

Answer 33

• What are the motivations for someone actually wanting to do this?
• Measure self-efficacy for taking treatment and motivation to do so (maybe they don’t want to)

Question 34

What are the lowest adherence rates in?

Answer 34

• Immediate discomfort or risk from the treatment (treatment not making you feel good = you will stop)
• Bad symptoms from treatment (not making you feel good = will not take them)
• Lifestyle changes are required (asking people to change diet, behaviours; more easy to take medications than change behaviour)
• Prevention instead of symptom palliation (feeling better) is desired outcome/emphasized (DO “You are already feeling this, this will help you feel better)
• Chronically ill who don’t see any immediate beneficial results from adhering (hard to keep something going on for long time/waiting for benefits)