Adhering to Medical Advice
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

Theories for adherence
(Compliance)
Behavioral theory
 Self-efficacy theory
 Transtheoretical model

Behavioral theory

Operant conditioning
– Reinforcement
• Positive
• Negative
– Punishment
– Rewards
• Extrinsic
• Intrinsic
Self-efficacy theory

Bandura’s Reciprocal determinism
– Person (thinking) + Behavior +
Environment

Self-efficacy (Person)
– Perceived control over yourself and your
environment
– Situation specific
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
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
How do you measure adherence?
1. Ask Practitioner
 2. Ask patient
 3. Ask others
 4. Monitor medication
 5. Biochemical evidence
 6. Combination of these

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
What factors predict adherence?
1. Severity of disease
 2. Treatment characteristics
 3. Personal characteristics
 4. Environmental factors

– Cultural norms
– Social support
Severity of disease

Pain is most likely to produce
compliance with medical advice
Treatment characteristics

Difficult, complicated, or painful
treatments reduce compliance
Personal characteristics

Compliance
– Depends on the situation
– Is not a global personality trait

Belief that treatment of ineffective or
harmful
– Decreases compliance
Environmental factors

Social support - increases compliance
– Living with a family
– Being married
Improving adherence
Clearly written instructions
 Verbal rewards
 Prompts from patient’s spouse
 Simple prescriptions
