1. Adherence to Medical Advice Chapter 4

2. 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

3. Theories Cognitive Behavioral is Most Explanatory Awareness - Precontemplation Attitude – Contemplation/Preparation Susceptibility Severity Cost/Benefit Barriers – Preparation Adherence – Action/Maintenance

4. Factors Predicting Adherence Illness Characteristics Severity of Disease Level of Distress (Pain) Treatment Characteristics Side-effects Duration Complexity

6. 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

9. 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

10. 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

11. 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

12. 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?