Wk11 Health Behaviour And Health Promotion Flashcards
What does patient compliance/adherence refer to?
- preventative health behaviours
- keeping medical appointments
- self-care actions (e.g. caring for wound)
- taking medication as directed (e.g. dose & timings)
- Insistence on discharge against medical advice
- Parents administering medication to children
What is non-adherence?
describes the failure of a patient to follow recommended health behaviours and treatment advice given by a clinician.
Why is non-adherence preferred over non-compliance?
Non-compliance = being told what to do
Non-adherence focusses better on a collaborative clinician-patient relationship and shared decision making
How good is patient compliance/adherence?
40-45% of patients consistently do not comply with doctors advice (Ley, 1997)
20-40% of recommended immunizations are not obtained
20-50% miss scheduled appointment
While patients comply with one treatment they may not comply with another
Varies by condition / multiple conditions
Beliefs about the effectiveness of the treatment
Good predictor of long-term adherence is adherence at entry Complex regimens have low adherence
Intrusive treatments have lower adherence
Expense decreases adherence
Adherence for asymptomatic conditions generally poorer
Why dont patients comply?
• Fear of side effects
• Side effects not worth benefits of
treatment
• Fear of dependency
• Fear of reduced effectiveness
• Does not fit with lifestyle
• Drugs/advice does not fit with health beliefs (or religious beliefs)
• Dissatisfaction with doctor recommendations/diagnosis
• Doctor fails to communicate adequately
• Don’t believe in the treatment
• Do not understand treatment process
• Doctors underestimate patients comprehension level
• Forgetfulness
• Financial (e.g. wait until pay day, take 1/2 dose to delay renewing prescription)
• Feeling sick
• Feel well (no need to keep going with treatment)
• Too busy - forget
• Life events, stress (e.g., death in family)
• Confused about dosage
• Drugs as a sign of weakness
• Travel away from home/holiday
When do patients comply?
Understanding
Memory
Satisfaction
Compliance
What is Stantons model of adherence?
Doctor communication + increased knowledge & satisfaction + patient’s beliefs, locus of control, perceived social support = adherence
Information - motivation - strategy model (Martin 2010)
- Information – Patients do not understand what they are supposed to do
- Motivation – Patients are not motivated to carry out their treatment recommendations
- Strategy – Patients do not have a workable strategy for following treatment recommendations
what is information?
- Communicate information effectively to patients;
- Build trust and encourage patients to participate in decision-making and to be partners in their own healthcare;
- Have patients share why and how they are to carry out their treatment recommendations;
- Listen to patients’ concerns and give them full attention.
What is motivation?
- Help patients to believe in the efficacy of the treatment;
- Elicit, listen to and discuss negative attitudes towards treatment;
- Determine the role of the patient’s social system in supporting or contradicting elements of the regimen;
- Help the patient to build commitment to adherence and to believe that they are capable of doing it.
What is strategy?
- Assists in overcoming practical barriers that stand in the way of patients effectively carrying out a course of action;
- Identify individuals who can provide concrete assistance;
- Identify resources to provide financial aid or discounts;
- Provide written instructions/reminders;
- Sign a behavioural contract;
- Link to support groups;
- Provide electronic reminders or follow-up phone calls.
How to improve adherence?
- Tell patient what you are about to tell them!
- Stress the importance of what you are about to say
- Think about primacy effect (i.e. the first thing you say will be remembered more than other things you say)
- Repeat instructions/ information
- The more patient is told, the higher the likelihood of forgetting part.
- Give specific advice
- Negotiate regimens which suit the patients’ routines
- Encourage patients to take notes
- Use simple words to describe body or treatment
- Try to change/adapt patients health beliefs
- Ensure patient understands rationale for treatment plan
- Try to anticipate barriers to compliance
What is the theory of planned behaviour?
– attitude towards behaviour
– subjective norm
– perceived behavioural control
Health belief model pt2
– perceived susceptibility – perceived severity – motivation – perceived benefits – perceived barriers – cues for action
What behavioural change techniques exist - the CALO-RE taxonomy
- taxonomy unpicks and describes all the individual components of behaviour change interventions
- particularly aimed at researches describing what they actually did
E.g. provide info, goal setting (behaviour or outcome) etc.
