When someone supports or sticks to a particular set of ideas or rules such as a medical regimen.
Why might patients not adhere to medical advice?
Rational choice theory - People may make the choice not to adhere for particular reasons such as:
- They have reason to believe that the treatment is not working (relevant for asymptomatic illnesses like hypotension).
- There are practical barriers to the treatment (e.g. cost or social difficulties)
- When the costs outweigh the benefits e.g. unpleasant side effects.
Psychoanalytic theory - explanations include avoidance &/or denial of the problem.
Bulpitt - Reasons for non-adherence
Aim: To review research on adherence in hypotension patients.
Methodology - A Review Article --> of a range of research which indentified problems with taking drugs for hypotension.
Procedure: The research was analysed to identify the physical & psychological effects of drugs on a persons life --> These included work, physical well being, hobbies etc...
Anti-hypotension drugs have many side effects such as sleepiness, dizziness & lack of sexual functioning -> they also affect cognitive functioning & so work and hobbies etc.
Bulpitt reported that...
- In one study by Curb (1985), 8% of males discontinued their treatment due to sexual problems.
- Research by the Medical Research Centre found that 15% of patients had stopped taking the drug due to other side effects.
Conclusion: When the costs of taking medication (e.g. side effects) outweigh the benefits of treating a mainly asympomatic illness, such as hypotension, there is less likelyhood of the patients adhering to their treatment.
Methods for measuring adherence:
Self report - using interviews, questionnaires, scales etc...
- Can produce unexpected information
- Can allow for social desireability bias
Physiological methods - e.g. blood & urine tests
- Can indicate whether a patient has been adhereing to their medical regimen.
- Reliable - can be easily replicated
- Not always possible/useful for all cases
- Ethics - using child patients?
Observing theraputic outcomes - e.g. if a patient was given antibiotics for an infection and a week later the infection had disappeared, then it is fairly safe to assume that they had been adhering to their treament (i.e. taking the antibiotics).
- Can observe the medicines effect on a persons health.
- Not possible/useful for all cases - There are cases when, despite strict adherence to treatment, the outcome isn't so positive.
Lustman - Measures of non-adherence
Aim: To assess the efficacy of the anti-depressant, Fluoxetine, in treating depression by measuring glycemic control.
Methodology - A randomised controlled double- blind study.
- 60 patients
- They either had type 1 or 2 diabetes and depression.
- Patients were randomly assigned to either Fluoxetine or placebo group.
- Patients were assessed for depression using psychometric tests, their adherence to their medical regimen (measured by measuring their GHb levels which indicated their glycermic control).
Patients given Fluoxetine reported lower levels of depression & had lower (nearer to normal) levels of GHb which indicated their improved adherence.
Greater adherence was shown by patients who were less depressed & anxious.
--> improves their compliance with medical regimen/requests.
Standardised procedure - using physiological tests which are easily replicated & unbiased.
* Positive reinforcment/operant conditioning -> Watt (Funhaler
* Increase education
- Early school programmes
- Media promotion
- Doctors & nurses
--> can increase perceived susceptiblity & seriousness & therefore internal LOC & self efficacy.
* Legislation -> enforcing of Laws (punishment - operant conditioning).
* Make medication more accessible.
Watt - Improving Adherence
Aim: To see if using a 'funhaler' can improve children's adherence to taking medication for asthma.
Methodology - A field experiment (although as it uses children with asthma, it can be considered a quasi-experiment).
The experiment sets up 2 conditions & then uses self report to measure adherence rates.
- 32 Australian children -> 10 boys, 22 girls.
- Aged 1.5 to 6 years (mean of 3.2 years)
- All diagnosed with asthma & prescribed drugs delived by pressurised metered dose inhalers (pMDI)
- Each child was given the Breath-a-tech for 1 week -> parents were given a questionnaire to complete.
- The 2nd week, the child used the Funhaler -> parents were given a questionnaire with matched questions at the end of the (2nd) week.
38% more parents were found to have medicaed their children the previous day when using the Funhaler.
The Funhaler reinforced correct usage of inhaler with spinner & wistle.
--> This improved adherence to the medication.
Therefore, by making the regimen fun, adherence (certainly in children) can be improved.