OCR psychology - Features of Medical Adherence

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.

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...

Findings:

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.

Aim: To assess the efficacy of the anti-depressant, Fluoxetine, in treating depression by measuring glycemic control.

Methodology - A randomised controlled double- blind study.

Participants:

• 60 patients
• They either had type 1 or 2 diabetes and depression.

Procedure:

• 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).

Findings:

Patients given Fluoxetine reported lower levels of depression & had lower (nearer to normal) levels of GHb which indicated their improved adherence.

Conclusion:

Greater adherence was shown by patients who were less depressed & anxious.

--> improves their compliance with medical regimen/requests.

Evaluative points:

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.

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.

Participants:

• 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)

Procedure:

• 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.

Result:

38% more parents were found to have medicaed their children the previous day when using the Funhaler.

Conclusion:

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.