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Adherence to Medical Advice
Chapter 4
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
Theories
Cognitive Behavioral is Most Explanatory Awareness - Precontemplation Attitude – Contemplation/Preparation
Susceptibility Severity Cost/Benefit
Barriers – Preparation Adherence – Action/Maintenance
Factors Predicting Adherence
Illness Characteristics Severity of Disease Level of Distress
(Pain) Treatment
Characteristics Side-effects Duration Complexity
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
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
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
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
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?