Help and Adherence Flashcards
How many people with symptoms actually seek help?
-1/3 of people
What do others do if they don’t seek help and why?
- Self-medicate
- Seek alternative therapies
- They are desperate or don’t trust the healthcare system
Unworried and unwell
- People who need care but don’t consult
- Actually sick but don’t think it is something to worry about
Worried well
- People who don’t need care and are consultuing
- People who seek help for everything
What are the components of illness representations? (6)
- 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?)
How does personality relate to control/cure?
- 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
What is illness coherence?
-What are my understandings of this symptom/disease I have?
What do illness representations do?
- 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?
How does social influence affect health-related behaviour?
- 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
What is compliance?
- 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!
What is adherence?
- 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
What is the challenge with adherence?
-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
What is non-adherence?
- 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
What is creative non-adherence?
- 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
What are reasons people use creative non-adherence?
- 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)
What measurement tool is commonly used to measure adherence?
-Questionnaires
How are the questions on the questionnaire tool?
- 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..”)
What is the rate of non-adherence with medical advice? People who do not follow short and long term plans respectively?
- 50%
- 38%
- 43%
People who don’t stick to recommended healthy lifestyles?
-75%
Dietary regimen compliance?
-30-70%
What happens with exercise program frequencies?
-50% drop out within 6 months
What type of data is better to get accurate reports?
- Self-reported data versus pedometer data
- Actual data reports less activity than what people report they do!
How do symptoms influence adherence?
- 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
How do treatments influence adherence?
- 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)
What personal factors influence adherence?
- Characteristics of the target person
- Characteristics of the person giving advice (do they care about me?)
- Normative influences (subjective/injunctive norms and descriptive norms)
Subjective norms
- Social pressure
- Do people who care about me want to do this?
Descriptive norms
- What do people like me do?
- If other people who have the same condition are doing this = easier to adhere to it
What is concordance?
- 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
What are the antecedents of adherence? (4)
- Understanding
- Memory
- Satisfaction
- Self-efficacy
How does understanding antecedents?
- 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?
How does memory antecedents?
- 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)
How does satisfaction antecedents?
- Easier to do something if you are happy about it
- Feeling satisfied with treatment = more likely to stick and adhere to it
How does self-efficacy antecede?
- 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)
What are the lowest adherence rates in?
- 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)
