Adhering to Healthy Behavior

Adhering to Healthy Behavior CHAPT ER 4 Adhering to Healthy Behavior Lecture Outline I. Issues in Adherence Two requirements are necessary for medical advice to be beneficial; first, it must be accurate and second, it must be followed. Two meta-analyses indicate a large difference in outcome for people who were adherent to their medication compared to those who were not. A. What Is Adherence? Adherence is a person’s ability and willingness to follow recommended health practices. B. How Is Adherence Measured? Researchers have used at least six methods to assess patient adherence: (1) ask the practitioner, (2) ask the patient, (3) ask other people, (4) monitor medication usage, (5) examine biochemical evidence, and (6) combine two or more of these procedures. All approaches have limitations, but the least valid method is to ask the clinician about rate of patient adherence. C. How Frequent Is Nonadherence? The rate of nonadherence to medical or health advice varies with a number of factors, but a meta-analysis of over 50 years of studies indicated that the average rate for failure to adhere was about 25%. The rate was better for some conditions such as HIV and arthritis but worse for conditions such as diabetes. D. What Are the Barriers to Adherence? There are many barriers to that impede patients heeding physicians’ advice. Barriers include cost of medication and cost of appointments. Patients may hold an optimistic bias- a belief that they spared the negative consequences of nonadherence that afflict other people. II. What Factors Predict Adherence? There are many factors that would logically seem to lead to adherence. A. Severity of the Disease Severity of the disease is actually a poor predictor of adherence, but the person’s perception of severity, especially pain associated with a disease, is a better predictor of adherence. B. Treatment Characteristics Treatment characteristics include unpleasant side effects of the medication and complexity of the treatment. 1. Side Effects of the Medication Early research found little evidence to suggest that unpleasant side effects are a major reason for discontinuing a drug or dropping out of a treatment program. Recent research indicates that patients who have concerns about severe side effects are less likely to take their medication than those individuals who do not have concerns about side effects. 2. Complexity of the Treatment In general, the greater the complexity of treatment, the lower the rate of adherence. Medication doses that cannot be cued to meals or bedtime (such as four or five doses per 60 lOMoAR cPSD| Adhering to Healthy Behavior day) result in lower adherence than those that can. The simpler and shorter the treatment schedule, the higher the level of adherence. C. Personal Factors Several personal characteristics relate to patient adherence. 1. Age Age shows a curvilinear relationship with adherence, with older and younger adults showing lower adherence. Older individuals have more barriers to adherence because they tend to have more complex medication schedules. Children with chronic conditions such as diabetes tend to become less compliant as they become adolescents. 2. Gender Few overall differences exist in adherence rates for women and men for most conditions, but women are more likely to adhere to a healthy diet that includes fruits and vegetables. 3. Personality Patterns No single personality trait shows any consistent relationship to adherence. Rather, nonadherence is more closely related to situational factors. 4. Emotional Factors Anxiety that is specific to the disease may improve adherence, but more general anxiety and stressful experiences tend to decrease adherence. Depression, however, presents a more serious problem for adherence. The factor of conscientiousness shows reliable relation to adherence.