New Zealand Respiratory Conference September 2013
Dr Kate Perry, Lead Health Psychology Specialist
Building unique support solutions for individual patient needs
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Asthma Preventer Non-adherence
• Common
– Between 30-70% of occasions (Bender et al., 1997)
– Likely an underestimate
• Not prompted to disclose in consultation
• Subject to social desirability and recall biases
• Costly
– Loss of health benefit (Stern et al., 2006)
– Economic cost (Hoskins et al., 2000)
• An uncontrolled patient is 3.5 x the cost of a controlled patient (£381 vs £108)
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3
"Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments”
Haynes et al. (2008)

Myth 1: Non-adherence is related to socio-demographic factors
• Age & gender
– Average correlation = 0 (DiMatteo, 2004)
• Education & income
– Average correlation < 0.1 (DiMatteo, 2004)
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Myth 2: Non-adherence is related to personality
• Limited evidence for a ‘non-adherent personality type’ (Hevey,
2007)
• Patients are ‘differentially adherent’ (McHorney & Gadraki,
2012)
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Patient Reasons for Medication Non-adherence
Unintentional non-adherence
Practical barriers
Intentional non-adherence
Perceptual barriers
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Unintentional Reasons for Medication Non-adherence
Unintentional non-adherence
Practical barriers
Practical reasons for not taking medication
Resource and ability limitations non-adherence
Perceptual barriers
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‘Practical’ Interventions
• Overcoming resource limitations
– Access
• Reducing cost
• Delivery
• Overcoming ability limitations
– Dexterity and technique
• Demonstration and instruction
• Health literacy
– Memory
• Aids and devises
• Establishing routine
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Patient Reasons for Medication Non-adherence
Conscious decision not to take medication
Motivations and beliefs non-adherence
Perceptual barriers
Intentional non-adherence
Perceptual barriers
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Intentional Reasons for Medication Non-adherence
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‘Perceptual’ Interventions
• Elicit patient beliefs about asthma
– “How long do you think your asthma will last?”
– “How serious do you think your asthma is?”
– “How much control do you feel you have over your asthma?”
• Elicit patient beliefs about preventer medication
– “How necessary do you think your preventer medication is?”
– “How concerned are you about taking your preventer medication?”
• Correcting ‘maladaptive’ beliefs
– Personalising the information
– Use of behaviour change techniques
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Summary
• Reasons for non-adherence vary
– Unintentional and intentional
• In consultation
– Elicit reasons from patient
– Offer solutions that are tailored
• Practical
• Perceptual
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