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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.

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adherence
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
Theories
  • Cognitive Behavioral is Most Explanatory
    • Awareness - Precontemplation
    • Attitude – Contemplation/Preparation
      • Susceptibility
      • Severity
      • Cost/Benefit
    • Barriers – Preparation
    • Adherence – Action/Maintenance
factors predicting adherence
Factors Predicting Adherence
  • Illness Characteristics
    • Severity of Disease
    • Level of Distress (Pain)
  • Treatment Characteristics
    • Side-effects
    • Duration
    • Complexity
predictors of adherence
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
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 relationship10
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
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
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?
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