Adherence to Medical Regimes.

Adherence to medical regimes for OCR psychology. health and clinical psychology. 

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Explanations of Non-adherence; Bulpitt.

Rational non-adherence = cognitive approach where you believe your behaviour is rational it is linked to the HBM. 

Aim; To review adherence in hypertensive patients. 

Method; Review article of research identifying problems with taking drugs for high blood pressure. Procedure; The research was analysed to identify the physical and psychological effects of druge treatments in someones life. This included physical activities and work and hobbies. 

Results; Anti-hypertension medication can cause many side effects including sleepiness, dizziness, and lack of sexual functioning in men. The medication also effected cognitive functioning meaning work and hobbies were curtailed. (An earlier study by Curb et el found 8% of men stoppped taking medication as it was making them sexually impotent). 

Conclusion; When costs of taking medication outweigh the benefits people are less likely to take the drug treatment. (Linked to the HBM on barriers and benefits). 

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Explanations of Non-adherence; Bulpitt.

Evaluation; There may be a case of researcher bias as because it is a review article Bulpitt may have chosen the evidence that only supported his view and his idea.

This would then mean that there may be a problem with the generalisability of the results. 

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Measuring Non-adherence; Barat.

There are a variety of methods that can be used. Subjective - self-reports, interviews and questionnaires. Objective - pill counts, physiological methods such as blood pressure, saliva, weight, urine/stool samples. 

Aim; To measure non-adherence of patients. (p's - 350, 70 year olds in Denmark). 

Method and Procedure; Interviews were conducted on their GP's to get their medical regimes. The researchers then went into the homes of the 70 year olds and conducted interviews with them. They also conducted a pill count. 

Results; In 22% of cases there were differences into how and when to take the medication between the GP and the OAP. In 71% of cases there were disagreements in the doses between the GP and the OAP. 24% didnt follow regimes with low doses. 60% knew the purpose of their drugs. 6% knew side effects only. 

Conclusion; People didnt follow regimes in they didnt know they drugs, if they had more than 3 to take and if they had bad memory on following a regime. 

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Measuring Non-adherence; Barat.

Evaluation; Ethics may be a concern. The patients may not have given consent for the researchers to go and do a pill count. furthermore this can be linked to the invasion of privacy as medical records etc are a private matter between the health department and the patient. 

There may be social desirability bias involved too. The patients may recognise the true aim and therefore on the interview lie to make themselves seem 'good' and like they do adhere. this will affect the validity of the study as then you are not really measuring what you think. 

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Improving Adherence; Watt et al.

There are many ways in which you can improve adherence. have to remember that there is a different population so different methods are going to apply the different people. 

Aim; To see if using a funhaler can improve childrens adherence to taking medication for asthma. 

Method; Field experiment. repeated measures design as the children used the funhaler for 1 week then a normal inhaler. (part of both conditions). (p's - 33 AUS children, aged 1.5-6 years and all diagnosed asthma and prescribed drugs delivered through an inhaler). 

Procedure; Each child used the normal inhaler for a week, parents were given a questionnaire. second week children took the funhaler and parents completed the same questionnaire. 

Results; 38% took drugs more regularly with the funhaler. Through the fun haler they also took the correct dose. 

Conclusion; Previous research suggests reasons for not taking such as boredom and forgetfulness. The fun haler with spinner, whistles etc reinforced correct dose and to take it. Did improve adherence. 

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Improving Adherence; Watt et al.

Evaluation; Ethics - will using a funhaler encourage children to take more drugs than what should be taken just because it is fun and a novelty to them? 

Dont know if this will work long term as the novelty of the whistles etc could wear off easily and as the study was only for a week we cannot see the long term effects of this and so we do not know the effectiveness of the treatment etc. 

Sample is small of 33 children and was done in Australia. Therefore the results are only represensative of children in Australia and therefore cannot be generalised to children everywhere all over the world. 

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