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
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Behavioral theory
Self-efficacy theory
Reasoned action & planned behavior
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
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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?
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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?
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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
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
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Clearly written instructions
Verbal rewards
Prompts from patient’s spouse
Simple prescriptions