What is meant by adherence?
How much a person’s behaviour follows what their healthcare provider recommends and is agreed on.
What is meant by non-adherence?
Failure to follow treatments and failure to attend appointments.
State the types of non-adherence.
- Failure to follow treatments (intentional or unintentional).
- Failure to attend appointments.
Describe intentional failure to follow treatments.
When a patient deliberately decides not to follow a treatment, due to:
- beliefs or preferences
- level of motivation
- thinking that they do not need treatment or that it will not work
Describe unintentional failure to follow treatments.
This occurs when a patient wants to follow treatment, but there are some barriers in the way, such as:
- not remembering or understanding what the doctor said.
- not being able to afford the treatment.
- not being able to take time off work for it.
State reasons of failure to attend appointments.
- age and work commitments.
- difficulties in getting to the hospital.
- being too ill to attend.
- feeling that the appointment is unnecessary.
- fear or mistrust of hospitals.
- fear that a serious illness might be discovered.
State problems caused by non-adherence.
- waste of medication.
- progression of illnesses.
- Time loss due to missed appointments.
- increased use of medical resources if left untreated.
Explain rational non-adherence.
- When a patient directly refuses to follow a treatment plan that they believe is both rational and justified.
- Maybe due to not wanting to suffer from side-effects.
Explain Laba et Al’s example study.
- To investigate how people decide whether to take their medication and what makes them intentionally not follow prescriptions.
- Used the Beliefs about Medication Questionnaire.
- Participants were asked to choose between two medications involving side-effects, cost, dosage frequency and alcohol restrictions.
- Findings portray participants with private medical insurance were less sensitive to the cost than those without.
- Most important factors in adherence to medication was the ability to reduce death and side effects severity
Explain the health belief model.
- Looks at factors which influence whether individuals will take preventative action when faced with a potential illness or injury.
- Perceived seriousness of the problem
- Perceived susceptibility
- Cues to action
- Perceived benefits and barriers
- Demographic variables
Explain how clinical interviews measure non-adherence.
- A dialogue between patient and clinician to help the professional gain information which will help with diagnosis and treatment.
Describe the study by Riekert and Droter
- Investigated the effects of non-participation on treatment adherence in adolescence with chronic health conditions.
- 94 families of adolescences, ages 11 to 18.
- 52 participants completed the study.
- 28 agreed to participate but did not return questionnaires.
- 14 participants did not consent to take part.
- participants completed a semi structured adherence interview and parents filled out a demographic information sheet.
- Results portrayed that the participants who didn’t return questionnaires tested their blood sugar levels significantly less frequently than others and also had lower rates of adherence to their treatment.
- In conclusion self-reports may not be a valid method for measuring non-adherence.
Explain how pill counting measures non-adherence.
- Objective method of measuring adherence.
- Calculates the percentage of prescribed medication a patient has taken by counting how many pills remain at the end of a specified period.
- Medication dispensers are portable devices that allow you to organise medication by day and time and can record the date and time a pill leaves the device.
Describe the example study by Chung and Naya.
- Aimed to investigate the effectiveness of electronically measuring adherence.
- 47 asthmatic patients, aged 18-55.
- Instructed to take one tablet every 12 hours.
- Each cap removal was presumed to indicate a single pill.
- If removed multiple times in a short period only one event was recorded.
- If open for more than 15 minutes, an additional event was recorded.
- participants were unaware of the electronic monitoring device.
- 64% of participants fully adhered.
- 20% of participants should under compliance.
- 10% of participants showed no adherence.
Explain how blood and urine samples can help measure non-adherence.
- Biological measures give objective measures of the amount of medication that has been taken.
- Urine analysis is a cheap and easy way to test for adherence.
- Both traditional methods of blood testing and dried blood testing are carried out.
Explain how to improve adherence in children.
- Making sure the regime is simple.
- Making medication easier to take, liquids rather than pills and giving them a pleasant taste.
- Use text messaging as a reminder with older children.
What is the funhaler?
- Based upon operant conditioning.
- Children will be rewarded if they use the device correctly encouraging them to use it more often.
- In this case rewards were spinners and a whistle.
Describe the example study by Chaney et Al.
- Aim to establish the acceptance, ease of use and compliance of the funhaler device.
- 32 children, ages 1.5 to 6, diagnosed with asthma.
- Informed consent was given and parents were interviewed using a questionnaire about their current asthma device.
- Funhaler was to be used instead of their current device for two weeks with adult supervision.
- Results portrayed significant increase in the percentage of children who had been medicated.
- Previous devices had a 10% success rate, the funhaler had a 73% success rate.
What are the three individual behavioural techniques?
- Contracts.
- Prompts.
- Customising treatment.
Explain the use of contracts for adherence.
Verbal or written contracts the patient makes with their healthcare professional that target at least one behaviour that the patient must commit to adhering.
Explain the use of prompts for adherence.
Can be effective at reminding patients to take medication or when their appointments are so they do not miss them.
Explain the use of customising treatments for adherence.
Tailoring treatment to best fit into the patient’s lifestyles and their abilities by choosing effective and appropriate behavioural techniques.
Describe the key study by Yokeley and Glenwick.
( aim - methodology - sample – result – conclusion)
- Aim of the study was to evaluate the effectiveness of four different conditions for motivating parents to immunise their preschool children.
- Field experiment with a longitudinal design, conducted in a naturalistic setting with a manipulated independent variable.
- 2101 preschool children , under the age of five, a register held at the public health clinic in the USA.
Final sample consisted of 715 children due to attrition. - children were randomly assigned to one of six conditions:
1. Mailed out general prompt.
2. Mailed out specific prompt.
3. Mailed out specific prompt plus extended hours.
4. Mailed out specific prompt plus a monetary incentive.
5. Contact control group.
6. No contact control group. - Significant differences were found between intervention groups across all outcome measures from highest to lowest impact.
- Using behavioural incentives to motivate parents to have their children immunised is effective
