Adherence

Question 1

What is Adherence?

Answer 1

The process by which patients take their medication as prescribed, described by three quantifiable phases: initiation, implementation and discontinuation
- (Vrijens et al., 2012)

Question 2

Types of Treatment Examples

Answer 2

• Medication (pills, injections etc)
• Lifestyle changes (stopping smoking, exercise)
• Attending Therapy
• Using a medical device (inhaler, CO2 monitor, heart monitor etc)

Question 3

Two impacts of Non-Adherence

Answer 3

Individual:
- increased disability
- decreased quality of life
- early retirement / reliance on carers

Society:
- higher healthcare costs
- more aggressive treatment
- claim benefits due to inability to work

Question 4

Two Types of Non-Adherence

Answer 4

Unintentional:
- practical barriers to adhering
- e.g. lacks resources/ability to obtain meds

Intentional:
- perceptual barriers to adhering
- e.g. not motivated and lacks belief in benefits of meds

Question 5

Measuring Non-Adherence

Answer 5

• self-report
• pill count
• bio assessments (blood, urine)
• electronic monitoring (MEMS)
• physiological outcomes
• pharmacy records
• GP records

Question 6

What is MEMS?

Answer 6

Medication Event Monitoring System:
- cap fits onto standard medical bottle
- cap contains microelectronic switch, clock, and memory chip

Question 7

4 Reasons for Non-Adherence

Answer 7

• patient related factors
• condition related factors
• treatment related factors
• system related factors

Question 8

Patient Related Factors

Answer 8

• Culture
• Age
• Personality
• Personal/religious beliefs
• Attitudes towards illness/medications -> stigma
• Self-Efficacy beliefs
• Addictions

Question 9

Common Related Factors

Answer 9

• Symptom type
• Perceived Severity
• Presence or absence of pain
• Presence of comorbidities

Question 10

Treatment Related Factors

Answer 10

• Number of treatments/medication
• Type of medication
• Duration and dosage of medication
• Presence of side effects
• Expense
• Practicality of obtaining medication

Question 11

System Related Factors

Answer 11

• Communication with health care professional
• Provision of info about medication
• Emphasis on necessity or function of medication
• Family values / Stigma
• Shared decision making
• Therapeutic relationships

Question 12

Challenges to Non-Adherence

Answer 12

• Recall bias / Self presentational bias / Pressure
• Not person-centered
• Counting pills
• Expensive
• Metabolism

Question 13

2 Social Cognition Models

Answer 13

Health Belief Model (Rosenstock, 1990)

Transtheoretical Model (Prochaska & Velicer, 1993)

Question 14

Health Belief Model

Answer 14

Rosenstock, 1990:
- Explains adherence as being impacted by an individual’s perceived benefits / threats / efficacy / barriers

Support (Khodaveisi et al., 2021):
- Education interventions based on HBM have been effective at improving people’s engagement with physical activity

Question 15

Transtheoretical Model

Answer 15

Prochaska & Velicer (1993):
- The model can be used to explain individual’s behaviours towards medication adherence at each stage and provides insight into what stage the person is at.

Support (Johnson et al., 2006):
- Participants in intervention group reported being in ‘Action’ and ‘Maintenance’ during follow up for Antihypertensive adherence