Health Psychology Chapter 4: Adhering to Medical Advice

Terms compliance adherence cooperation _______________

I. Theories of Adherence Behavioral Model Cognitive Learning Models –__________________________ –Theory of Reasoned Action –Health Belief Model

Health vs. Adherence Models Health Belief Model Theory of Reasoned Action Theory of Planned Behavior ___________________ Precaution Adoption Process Model Transtheoretical Model Health Belief Model Theory of Reasoned Action Self-Efficacy Theory Behavioral Model

Medication Adherence Examples Size of dose Number of doses ________ of doses Duration of treatment

II. Measuring Adherence Dr report Pt report _______________ Pharmacy records Behavioral observation (e.g., pill counts) Blood/urine tests

Example: Lung disease drug (theophylline) Estimates of % of pts prescribed drug: –Dr reports: 78% –_______________ : 62% –Videotapes of pt visits: 69% –Pt reports: 59%

III. Predicting Adherence A. Illness characteristics –Illness severity –Medication side effects –_______________ –Tx complexity

B. Personal characteristics –Age –Gender –Social support –Emotional support –_______________ –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 –_______________ –behavioral instructions, not jargon –info about disease –info about specific tx requirements –not beginning with _____ –pts forget/misunderstand ______%

Jargon Translated _______ test resultnormal result (good news) Idiopathicunknown reason Contraindicateddon’t do it Lesionsore or damage Analgesicpainkiller Hematomabruise (swollen from blood) Thrombosisblood clot Subclinicalnot yet detectable Traumainjury

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? –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 –more effective –__________________ –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