1. Adhering to Medical Advice
Assist. Prof. Merve Topcu
PSY 411 Health Psychology
Department of Psychology Çankaya University
, Fall

3. Theories for adherence / compliance
Behavioral theory
Self-efficacy theory
Theories of Reasoned Action & Planned Behavior
The transtheoretical model

4. 1. Behavioral theory Based on Operant Conditioning Reinforcement
Positive
Negative
Punishment
Rewards
Extrinsic
Intrinsic

5. 2. Self-efficacy theory Bandura’s social-cognitive theory
Reciprocal determinism
Person (thinking) + Behavior + Environment
Self-efficacy (Person)
Perceived control over yourself and your environment
Situation specific, not global + outcome expectation
Smoking cessastion & diabetic diet

6. 2. 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. 3. Theories of Reasoned Action & Planned Behavior

8. 3. Theories of Reasoned Action & Planned Behavior
The theory of planned behavior
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9. 4. The Transtheoretical Model of change
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

10. What is adherence? Compliance Adherence
Patient’s behaviour that conform to phisicians orders
Adherence
A person’s ability & willingness to follow recommended health practices

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

12. Factors predicting adherence
Severity of disease
Pain level
Seriousness of disease / disorder
Treatment characteristics
Side effects
Complexity of treatment
Personal characteristics
Age
Gender
Personality
Obsessive & compulsive features
Hostility
Level of anxiety
Effects of stresful life events
Self-efficacy
Avoidance coping
Responsibility
Environmental factors
Cultural norms
Social support
R/ship btw health care provider & patient

13. Reasons for nonadherence
Requirement
Vagueness of physician advice
Unhealthy lifestyles
Optimistic bias
Finding hard to attach a treatment or phisician

14. Improving adherence Educational Behavioral methods
Emotional regulation
Health education
Behavioral methods
Aims to change patient behaviors
Reducing economic barriers
Rewarding
Notifying of upcoming appointments
Simplifying medical schedules
Home visits
Prompts
Tailoring regimen
Graduated regimen
Verbal commitment and /or contingency contract
Encouraging self-reinforcement
Service fee

15. To be continued...