Watt - Adherence to Medical Regimes

Question 1

Cognitive approach

Answer 1

Adherence can be improved by increasing benefits and reducing the costs.
Bulpitt & HBM.

Question 2

Social approach

Answer 2

Concentrate on improving techniques to help patients remember. = Kent
Train doctors in skills and communication. =Waitkin.

Question 3

Behavioural approach

Answer 3

Change adherence through learning by conditioning.

Watt

Question 4

Watt’s observation

Answer 4

‘adherence does not necessarily improve with rising severity of illness’ - CONTRADICTS HBM
therefore thought better to try behavioural approach.

Question 5

Aim

Answer 5

to see if funhaler can improve use of children’s asthma medication

Question 6

Method

Answer 6

Field experiment

Compares two asthma inhalers with a self-report method

Question 7

Participants

Answer 7

32 Australian asthmatic children
10 boys, 22 girls
1.5-6 years (mean 3.2)
All diagnosed with asthma

Question 8

Design

Answer 8

Repeated measures
1 week Breth-a-Tech (traditional asthma inhaler for children)
1 week Funhaler (same medication + face mask = has incentive toys in the form of spinner and whistle… function best when children use deep breathing pattern that ensures the effective inhalation of the medication)

Question 9

Procedure

Answer 9

Questionnaire for parents at end of each week

Question 10

Findings

Answer 10

• 38% more parents were found to have dedicated their children the previous day when using the Funhaler compared to existing treatment.
• 60% more children took the recommended four or more cycles per aerosol delivery when using the Funhaler compared to Breath-a-Tech.
• Chaney - found parents and children more successful, positive and happy using the funhaler.
• reports of always being successful = 3/30, Breath-a-Tech, 22/30 = Funhaler
• 13 children showed signs of fear, panic or phobia using original spare. None for funhaler, 21 reported pleasure.

Question 11

Conclusions

Answer 11

Previous research: non-adherence by child asthmatics due to child resistance (crying) and forgetfulness.
Funhaler improved adherence to medication.
Reinforcement of making regime fun improved the childs adherence.
Rewarding nature from correct action supports behaviourist approach of operant conditioning. Positive reinforcement.
Rewarded visually from spinner or whistle if they breathe correctly whilst dose of asthma medication is delivered.

Question 12

Reductionist

Answer 12

Breaking down a complex behaviour down into its simplest components.
Ignores other approaches eg. Ley

Question 13

Why funhaler?

Answer 13

Rates of compliance for offering medication regularly to asthmatic children range from 30%-70%
Correct usage of inhalers = higher variable.
Crying impede effective delivery.
Adherence does not correlate with severity of illness.
Doctors do not always assess patient adherence accurately.
Poor medication leads to higher rates of hospital admissions and increased complications
Education may work but less effective with children.

Question 14

Ethics

Answer 14

Parents gave informed consent.

Question 15

Validity

Answer 15

1: Parents may give socially desirable answers.
2: Demand characteristics of parents who may have wanted the funhaler to work.
3: Hawthorne effect:
- trying to measure effectiveness of intervention but improvement may have been due to novelty which could have worn off fairly quickly after initial weeks use; rather than improvement being due to intervention task itself. Therefore not measuring effectiveness of funhaler.

Question 16

Reliability

Answer 16

1: order effects of repeated measures design.. not stated if research was counterbalanced.
2:
Conducted over a short time span (2 weeks)
Adherence may have improved with use of funhaler over time hence produce different findings.

Question 17

Useful

Answer 17

• Funhaler useful for management of young asthmatics.
• Practical application that functional incentive devices may improve health of children.
• Not possible to generalise findings to adults.
• Longitudinal study to eliminate Hawthorne effect as would not be measuring the effect of something new to children (funhaler).

Question 18

Ley (social)

link to reductionism

Answer 18

Patient anxiety influenced the ability understand and remember medical regimes.

1: primacy effect -Patients remembered best the first thing they were told.
2: Repetition of information made no difference
3: recalled 65% all of visual and oral information after 3 days. (20% visual, 10% oral)

Question 19

Kent (social)

link to reductionism

Answer 19

Problem or understanding and memory