Transcript Health Psychology

Chapter 4: Adhering
to Medical Advice
Health Psychology
Terms
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compliance
adherence
cooperation
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I. Theories of Adherence
• Behavioral Model
• Cognitive Learning Models
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– Theory of Reasoned Action
– Health Belief Model
Health vs. Adherence Models
Health Belief Model
Theory of Reasoned
Action
Theory of Planned
Behavior
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Precaution Adoption
Process Model
Transtheoretical Model
Health Belief Model
Theory of Reasoned
Action
Self-Efficacy Theory
Behavioral Model
Medication Adherence Examples
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Size of dose
Number of doses
________ of doses
Duration of treatment
II. Measuring Adherence
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Dr report
Pt report
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Pharmacy records
Behavioral observation (e.g., pill counts)
Blood/urine tests
Example: Lung disease drug
(theophylline)
• Estimates of % of pts prescribed drug:
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Dr reports: 78%
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Videotapes of pt visits: 69%
Pt reports: 59%
III. Predicting Adherence
• A. Illness characteristics
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Illness severity
Medication side effects
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Tx complexity
• B. Personal characteristics
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Age
Gender
Social support
Emotional support
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Personal beliefs
• C. Cultural Norms
Types of Problem Pts (Groves)
1) Dependent clinger
 Firm enforced ________________________
2) Entitled demanders
 Reassure of rights, address fear, direct energy
towards coping
3) Manipulative help rejecters
4) Self-destructive denier
 Psychological help (source of destructiveness)
D. Practitioner-Patient Interaction
• Communication
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behavioral instructions, not jargon
info about disease
info about specific tx requirements
not beginning with _____
– pts forget/misunderstand ______%
Jargon Translated
_______ test result
Idiopathic
Contraindicated
Lesion
Analgesic
Hematoma
Thrombosis
Subclinical
Trauma
normal result (good news)
unknown reason
don’t do it
sore or damage
painkiller
bruise (swollen from blood)
blood clot
not yet detectable
injury
• Practitioner characteristics
– technical competence
– warm, caring, friendly, concerned
– not _______________
• Time between referral & tx
• Time to wait to see practitioner
IV. Understanding Adherence
• A. Why nonadherence?
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lifestyle changes are difficult
don’t hear advice
don’t understand advice
seems too difficult/time-consuming/expensive
quit meds once they have worked/ don’t work
trouble ___________________________
optimistic bias (won’t have neg consequences)
B. How to Improve Adherence?
• Education
– not that effective
• Behavioral strategies
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more effective
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simple prescriptions
prescription tailored to pt’s schedule
cues for meds
– follow-up calls for missed apts
– involve spouse, support network
– reward compliance
C. Does Adherence Pay Off?
• MAYBE
– results are mixed
– _______________ = caused by tx
e.g., abdominal surgery that punctures bowels
(result: periotonitis)
– Handwashing