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)
