Health PsychologyTermsI. Theories of AdherenceHealth vs. Adherence ModelsMedication Adherence ExamplesII. Measuring AdherenceExample: Lung disease drug (theophylline)III. Predicting AdherenceSlide 9Types of Problem Pts (Groves)D. Practitioner-Patient InteractionJargon TranslatedSlide 13IV. Understanding AdherenceB. How to Improve Adherence?Slide 16C. Does Adherence Pay Off?Health PsychologyChapter 4: Adhering to Medical AdviceTerms•compliance•adherence•cooperation•_______________I. Theories of Adherence•Behavioral Model•Cognitive Learning Models–__________________________–Theory of Reasoned Action–Health Belief ModelHealth vs. Adherence ModelsHealth Belief ModelTheory of Reasoned ActionTheory of Planned Behavior___________________Precaution Adoption Process ModelTranstheoretical ModelHealth Belief ModelTheory of Reasoned Action Self-Efficacy TheoryBehavioral ModelMedication Adherence Examples•Size of dose•Number of doses•________ of doses•Duration of treatmentII. Measuring Adherence•Dr report•Pt report•_______________•Pharmacy records•Behavioral observation (e.g., pill counts)•Blood/urine testsExample: Lung disease drug (theophylline)•Estimates of % of pts prescribed drug:–Dr reports: 78%–_______________ : 62%–Videotapes of pt visits: 69%–Pt reports: 59%III. Predicting Adherence•A. Illness characteristics–Illness severity–Medication side effects–_______________–Tx complexity•B. Personal characteristics–Age–Gender–Social support–Emotional support–_______________–Personal beliefs•C. Cultural NormsTypes of Problem Pts (Groves)1) Dependent clingerFirm enforced ________________________2) Entitled demandersReassure of rights, address fear, direct energy towards coping3) Manipulative help rejecters4) Self-destructive denierPsychological help (source of destructiveness)D. Practitioner-Patient Interaction•Communication–_______________–behavioral instructions, not jargon–info about disease–info about specific tx requirements–not beginning with _____–pts forget/misunderstand ______%Jargon Translated_______ test result normal result (good news)Idiopathic unknown reasonContraindicated don’t do itLesion sore or damageAnalgesic painkillerHematoma bruise (swollen from blood)Thrombosis blood clotSubclinical not yet detectableTrauma injury•Practitioner characteristics–technical competence–warm, caring, friendly, concerned–not _______________•Time between referral & tx•Time to wait to see practitionerIV. Understanding Adherence•A. Why nonadherence?–lifestyle changes are difficult–don’t hear advice–don’t understand advice–seems too difficult/time-consuming/expensive–quit meds once they have worked/ don’t work–trouble ___________________________–optimistic bias (won’t have neg consequences)B. How to Improve Adherence?•Education–not that effective•Behavioral strategies–more effective–__________________–simple prescriptions–prescription tailored to pt’s schedule–cues for meds–follow-up calls for missed apts–involve spouse, support network–reward complianceC. Does Adherence Pay Off?•MAYBE–results are mixed–_______________ = caused by txe.g., abdominal surgery that punctures bowels (result: