ADHERENCE
Theoretical models:
Behavioral model,Self-efficacy theory
Theory of reasoned action and planned
behavior, and transtheoretical model.
• Behavioral Therapy
– Positive reinforcement
– Negative reinforcement
– Punishment
• Self-efficacy Theory
• Albert Bandura proposed a social cognitive
theory.
• Individuals use their cognitive processes for
self-regulation.
• Human action results from an interaction of
behavior, environment and person factors,
especially cognitions.
• Bandura referred this interactive triadic model
as reciprocal determinism.
• Denoted by triangle.
• An important component of person factor is
self-efficacy, people’s beliefs in their capability
to exercise some measure of control over their
own functioning and over environmental
events.
• Self-efficacy can be acquired, enhanced or
decreased in four ways; performance,
vicarious experience, verbal persuasion and
physiological arousal states i.e anxiety which
decrease self-efficacy.
• Adherence is the extent to which a person is able
and willing to follow medical and health advice.
• In order to profit from adherence; first, the
advice must be valid and second ,patient must
follow advice.
• Six ways of measuring adherence; ask the
practitioner, ask the patient, ask other people,
monitor medical usage, examine biochemical
evidence and use a combination of these
procedures.
• Asking the practitioner is usually the poorest
choice.
• No one of these procedure is both reliable and
valid.
•
FACTORS PREDICT ADHERENCE
• Severity of the disease
• Treatment characteristics; side effects and
complexity of treatment.
• Personal factors; age, gender, personality
patterns, emotional factors, personal beliefs.
• Environmental factors; economic factors,
social support.
• Cultural norms.
• Practitioner- patient interaction; verbal
communication, practitioner’s personal
characteristics.
– HOW CAN ADHERENCE BE IMPROVED?
• Knowing the barriers.
• Four approaches; providing prompts, tailoring
the regimen, implementing the regimen
gradually, and making a contingency contract.