Adherence to Medical Advice

Chapter 4

Adherence

Adherence refers to the patient’s ability and willingness to follow recommended health practices.

It is an issue of MAINTENANCE In general nonadherence remains

at about 50% across a number of different health behaviors

Theories

Cognitive Behavioral is Most Explanatory Awareness - Precontemplation Attitude – Contemplation/Preparation

Susceptibility Severity Cost/Benefit

Barriers – Preparation Adherence – Action/Maintenance

Factors Predicting Adherence

Illness Characteristics Severity of Disease Level of Distress

(Pain) Treatment

Characteristics Side-effects Duration Complexity

Predictors of Adherence

Age Interaction effect Curvilinear relationship

below 55, around 70, over 80 Gender

Women sometimes better (exercise) Social Support

Positive relationship Cultural Norms

Factors Predicting Adherence Practitioner-Patient

Relationship Communication – How the message is

delivered Verbal

Simple language Importance Have patient repeat Partnership statements Positive statements Waiting

Nonverbal Eye-contact Smiling Leaning forward

Factors Predicting Adherence:

Practitioner-Patient Relationship

Clinician characteristics – Who is delivering it Technical ability

Males perceived to be > than females (NOT TRUE)

Warm, caring, friendly, & interested in the patient

As a group female physicians better at these than males

Improving Adherence Education is ineffective alone Self-monitoring Prompts-cued by regular events, calls,

beepers, etc. Tailor regimen to fit the treatment to the

patient’s life. Graduated regimen implementation. Contingency Contract - agreement for a

reward based on behavior Home Visits Support Groups

Effectiveness of adherence

Correlational studies show poor adheres 2 1/2 time more likely to die than good adherers.

Some self-report studies inconclusive

Noise in the data What is the outcome measure?