adherence and beliefs Flashcards
(25 cards)
what model is about self regulation of illness related behaviour
leventhals common sense one
what is leventhals common sense one
the self regulation of illness-related behaviour:
advice -> patient -> illness-related behaviour
Peoples’ view about their need for a treatment are influenced by: what 2 things
- Their ‘common-sense’ understanding (beliefs) about the illness
- symptom experiences relative to expectations
what things might reinforce the perception that the treatment is not that important
- taking the maintenance treatment does not make the patient feel better
- missing doses does not make them feel worse
Applying the Extended Common Sense Model to explain doubts about treatment Necessity:
- what type of condition is hypertension
Hypertension is an asymptomatic condition.
so what is the emphasis of hypertension treatment on
prevention and avoiding illness
so why might hypertension not seem like a big deal
These future risks can seem quite distant and obscure to the patients.
why might patients become demotivated
Patients may not feel any benefit from the taking the medication. They may even feel worse if the medication causes side-effects. This may mean that they become demotivated
why might they think they don’t need long term treatment
- Patients may believe that if their blood pressure becomes well controlled after taking medication that they no longer need it long-term.
- They may think they have achieved a cure and may think they can drop out treatment.
conclusion:
Patient is not a ‘blank sheet’
- They have pre-existing ideas about their condition, beliefs and expectations of the treatment
- These are usually logical, ‘common-sense’ interpretations of the condition and treatment; they make sense from the patient’s perspective, but are often mistaken from a medical perspective
- Taking account of user perspectives is essential to support informed choice and adherence
what are the 4 myths of non-adherence
1: non-adherence is a feature of the disease
2: the non-compliant deviant patient
3: simplifying the regimen and reducing pill-burden solves the problem of nonadherence
4: providing more information about a therapy guarantees adherence
dispelling myth 1 - Non-adherence is a feature of the disease
(yet low adherence rates are problematic in most chronic diseases e.g. HIV, Cancer, Heart disease, Kidney, Diabetes, Asthma)
dispelling myth 2 - The ‘non-compliant’ (deviant) patient
(No clear and consistent links between adherence and age, gender, intelligence, marital status etc: Findings are inconsistent e.g.
non-adherence linked to older age in some studies and to younger age in others)
Adherence/nonadherence as best understood as the interaction between an individual and a particular illness and treatment
dispelling myth 3- Simplifying the regimen and reducing ‘pill-burden’ solves the problem of nonadherence
(simplifying the regimen can be helpful for some patients: BUT this alone will not solve the adherence problem. Complexity per se is not the key issue but how well the treatment fits in with the individual patient’s routine, expectations and preferences WE NEED TO LOOK BEYOND ‘THE PRODUCT)
dispelling myth 4 - Providing more information about a therapy guarantees adherence
for information to change behaviour it needs to bridge the information action gap:
to result in action, information must either agree with our existing beliefs, or change them
what is the first barrier we need to cross for non-adherence
beliefs: if the patient doesn’t want to do it, making it easier is unlikely to work
what are PHARMACETICAL SCHEMA
how patients’ specific beliefs about medicines prescribed for them are influenced by ‘background beliefs’ about pharmaceuticals as a class of treatment and by their perceptions of personal sensitivity to medicines
Medication Concerns - what can influence personal preferences for treatment
public suspicion of pharmaceuticals and pharmaceutical industry influence personal preferences for treatment
what can diminish public trust:
– Medical technology and science
Increasing concerns:
– Chemicals in the environment
– Other ‘modern health worries’
why is chemical vs natural medicines an issue
in public perceptions the harmful nature of medicines is often linked to their chemical origins which is adversely contrasted with more ’natural’ and therefore ‘safer’ remedies
Compliance meaning
– The extent to which the patient’s behavior matches the prescriber’s advice. [Haynes & Sackett, 1979]
Adherence meaning
– See above but attempt’s right to acknowledge patient’s right to decline
treatment and non-compliance is no reason to blame the patient– the extent to which patient’s behavior matches an agreed action. [Barnofsky, 1985]
Concordance meaning
– More complex and less succinctly defined idea relating to the conduct and outcome of prescribing-related consultations.
