Adherence to Medical Regimes

Reasons for non-adherence - Bulpitt

Measures of non-adherence - Lustman 

Improving adherence using behavioural methods - Watt

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Reasons for non-adherence to medical regimes - Bul

  • What is the theory behind Bulpitt?
  • What was the method in Bulpitt? 
  • What were the findings/conclusions in Bulpitt? 
  • What are some possible evaluation points for Bulpitt?
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Reasons for non-adherence to medical regimes - Bul

  • One reason why people do not keep to the medical regime advised by doctors is because they think the side effects outweigh the benefits. This is known as "rational non-adherence" and is linked to the Health Belief Model 
  • Review of research on adherence in patients with high blood pressure. The research was analyzed to identify the physical and psychological effects of the drug treatment. 
  • While the drug did reduce the number of headaches and the extent of their depression compared to the re-drug states many participants stopped taking the drug due to side effects such as sleepiness, dizziness and lack of sexual function. 
  • 1. Cognitive bias - do patients make errors in judgment about the potential risks of taking blood pressure medication? 2. Validity - maybe even more withdrew from the medication but did not want to admit why? 3. Research articles may be subjective due to researcher bias.
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Measures of non-adherence to medical advice - Lust

  • What are the main ways in which non-adherence to medical regimes is measured? 
  • What was the method in Lustman? 
  • How was adherence measured in Lustman?
  • What were the findings/conclusions in Lustman? 
  • What are some possible evaluation points for Lustman?
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Measures of Non-adherence to Medical Advice - Lust

  • 1. Subjective methods - qualitative data e.g. asking practitioners about a patient. 2. Objective measures - quantitative data - often better, e.g. pill counting, however this is flawed as just because a pill is missing from a bottle doesn't mean it has been taken. 3. Improved measurement is physiological measures e.g. urine & blood tests. 
  • Recorded the blood sugar levels of people with diabetes. Controlled double blind study of 60 patients with type 1 or type 2 Diabetes - randomly assigned to Fluoxine or placebo group. 
  • Adherence measured by measuring GHb levels, which indicated glycemic control. Also given psychometric tests to measure levels of depression. 
  • Patients given Floxetine reported lower levels of depression and had lower levels of GHb. Previous research suggests that reducing depression may improve adherence, therefore this suggests that measuring GHb levels in patients with diabetes indicates their level of adherence to a drug regime. 
  • 1. Comparison between different methods 2. Effectiveness - Physiological methods are most reliable, however unlikely that in everyday life anyone would regularly record physiological states 3. Researcher bias and demand characteristics reduced to use of double blind procedure 4. Psychometric test for depression - social desirability bias & Demand Characteristics
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Improving adherence using behavioural methods - Wa

  • What is the theory behind Watt? 
  • What was the method in Watt? 
  • What were the findings/conclusions in Watt? 
  • What are some possible evaluation points for Watt?
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Improving adherence using behavioural methods - Wa

  • Studies have shown that adherence to a medical regime can be improved by medical practitioners emphasising and repeating key information and not using medical jargon. Behaviourist strategies based on classical conditioning have also been used. 
  • Study to see if the use of a "Funhaler" would help improve children's to taking medication for asthma 
  • 38% more parents were found to have medicated their children the previous day when using the Funhaler when compared with existing treatments 
  • 1. Linked to the behaviourist approach - based on behaviourist principles - reductionist 2. Limited application - would this technique work with adults? Would adult behaviour be more complex (link with Cognitive bias issue discussed in Bulpitt)
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