1. Adhering to Medical Advice

2. Basic ideas Do not take left over medications Do not stop taking medicine whenever you begin to feel better Do not quit your medication even if you feel worse after taking it Even if it makes you feel bad, take the medicine anyway

3. Theories for adherence Behavioral theory Self-efficacy theory Reasoned action & planned behavior Transtheoretical model

4. Behavioral theory Operant conditioning –Reinforcement Positive Negative –Punishment –Rewards Extrinsic Intrinsic

5. Self-efficacy theory Bandura’s Reciprocal determinism –Person (thinking) + Behavior + Environment Self-efficacy (Person) –Perceived control over yourself and your environment –Situation specific

6. Self-efficacy Beliefs predict accomplishment Acquired, increased, or decreased by: 1. Performance 2. Vicarious experience –Seeing others of similar skills perform 3. Encouragement 4. Physiological arousal –Anxiety, or high expectation

7. The Transtheoretical Model Stages of change model 1. Precontemplation stage –Has not thought about changing 2. Contemplation stage –Only thought about changing 3. Preparation –Thoughts & preparation for change 4. Action stage –Actually making the change 5. Maintenance stage –Resists temptation to go back

8. How do you measure adherence? 1. Ask Practitioner 2. Ask patient 3. Ask others 4. Monitor medication 5. Biochemical evidence 6. Combination of these

9. Accuracy of measurement 1. Practitioner –Slightly better than chance 2. Patient –Inaccurate because: Do not know Lie to exaggerate success 3. Others Constant observation is impossible Artificial - Unrealistically high reports 4. Medicine usage Patient may not have taken the medication 5. Biochemical evidence (blood, urine) People vary in response to drugs

10. What factors predict adherence? 1. Severity of disease 2. Treatment characteristics 3. Personal characteristics 4. Environmental factors –Cultural norms –Social support

11. Severity of disease Pain is most likely to produce compliance with medical advice

12. Personal characteristics Compliance –Depends on the situation –Is not a global personality trait Belief that treatment of ineffective or harmful –Decreases compliance

13. Environmental factors Social support - increases compliance –Living with a family –Being married

14. Improving adherence Clearly written instructions Verbal rewards Prompts from patient’s spouse Simple prescriptions