Adhering to Health

Behavior
What is Adherence?
- a persons ability and willingness
to follow recommended health
practices.
How Adherence is measured?
1. Ask the practitioners - Physicians generally over
estimate their patients’ adherence rates, and even when
their guesses are not overly optimistic, they are usually
wrong. (poorest choice among methods)
2. Ask the patients - (method has difficulties) - self
reports are inaccurate)
- (1. patients tend to report behaviors that make them
more adherent, 2. they may simply not know their own
rate of adherence)
3. Ask hospital personnel and family members to monitor the
patient - but this methods has downfalls;
(1. constant observation may be physically impossible;
2. persistent monitoring creates an artificial situation and
frequently results in higher rates of adherence than would
otherwise occur)
4. Objectivity monitor a person’s behavior - this occur by
monitoring a patient’s medicine usage such as counting pills or
assessing wether patients obtain prescription or refills.
5. Examination of Biochemical evidence - such as analysis of
blood or urine samples that reflect adherence, to determine if
the patient bahaves in an adherent fasion
HOW FREQUENT IS NONADHERENCE?

- SACKETT AND SNOW(1979), found a higher rates for

patients keeping appoinments when patient iniated the
appointment(75%) than when patients appointments were
scheduled for them (50%). As expected, adherence rates
were higher when treatment was meant to cure than to
prevent a disease. However adherence was lower for
medication takenb for chronic condition over a long period,
adherence was around 50% for either prevention or cure
What factors predict adherence
Severity of
Disease
Environmental
Personality Factors
Factors

Treatment
Characteristics
 Treatment Characteristics
Side Effects of medication
- more recent research with diates medications (Mann
Et. Al 2009) and the complex regimen of hiv medication
(Applebum Et. Al 2008) shows that those who
experience or have concerns about severe side effects
are less likely to take their medications than who do
not have such concern
Treatment Characteristics
Complexity Treatment
- the greater the number of
doses or variety of medications
people must take the greater the
likelihood that they will not
take the medicine as prescribed
 Personal Factors
Age
- Thomas ET Al., 1995 found out a
curvilinear to colorectal cancer screening,
that is those who adhered best were
around 70 years old among other age
groups.
- Even with caregivers to assist them,
childrenwith asthma (Penza Et., Al 2004),
diabetes (Cramer, 2004) and HIV infection
(Farley Et,. Al 2004) often fail to adhere to
their medical regimen
 Personal Factors
Personality Patterns
- people cannot be easily
classified as “Adherent” and
“NonAdherent” across many
behaviors. Thus, the evidence
suggests that nonadherence is
not a global personality trait,
but is specific to a given
situation (Haynes 2001)
 Personal Factors
Emotional Factors
- people who experience several sressful events are likely
to dropout from an exercise program (Oman and King.,
2000)
- individuals taking aniretroval medicationfrom HIV who
reported high levels of stress were less adherent
(BottonAri Et Al., 2008).
- the risk of Non Adherence mis 3 times greater in
depressed patients than in those who are not depressed.
(Gonzales Et Al,. 2008)
- the trait of conscienciouness shows a relationship to
adherence and improved health.
Environmental Factors
Social Support
- refers to both intangible and tangible help a
person receive from family and friends
- the level of social support one receives, is a
strong predictor of adherence. In general
peopkle who are isolated from others are likely
to be nonadherent
- social support may consist of either practical
and emotional support. Practical support
includes reminders and physical support
includes nurturance and emphathy
Environmental Factors
Cultural Norms
- cultural beliefs and
norms have a powerful
effect not only on rates of
adherence but also on
what constitutes
adherence
 Continuum Theories of Health Behavior
- Continuum theories are a
name given to theories that
seek to explain adherence
with a single srt of factors
that should apply equally to
all people regardless of their
existing levels or motivations
for adhering.
1. Percieved susceptibily to disease or
disability.
2. Percieved severity of the disease or
disability.
3. Percived benefits of health
enhancing behaviors.
4. Percieved benefits to health
enhancing behaviors.
 Self Efficancy Theory
- Albert Bandura
- Self efficacy - people’s beliefs in their capacity
to exercise some measure of control over their own functioning and over
environmental events.
Self Efficancy can be acquired, enhanced or decreased in one of four ways:
1. Performance/Enacting a behavior
2. Vicarious experience/seeing another person with simnilar skills perform a
behavior
3. Verbal Pesuasion, or listing to the encouraging words of a trusted person
4. Physiological arousal states, such as feelings of anxiety or stress (which
ordinary decrease efficacy
- according to self efficacy theory, peoples beliefs
concerning their ability to iniate difficult
behavoirs predict their likehood of
accomplishings those behaviors.
People who think they can do something will try
and persist at it; people who do not believe they
can do something will not try or give up
easily.Also outcome expectations are important to
self efficacy theory,This expectation refers to
people’s belief that those behaviors will produce
valuable outcomes.
1. One’s attitude towards the behavior. This arrises from
beliefs that the behavior will lead to positively or negatively
valued outcomes
2. Perception of how much control exists over one’s
behavior. (the ease or difficulty in anchieving the desired
behavioral outcomes
3. One’ s perception of the social pressure to perform and not
to perform the action; That is one’s subjective norm. One’s
subjective norm is shaped by both one’s belief that the other
people encourage the behavior, as well as one’s motivation to
adhere the wishes of others
 Behavior Theory
Positive reinforcement - a positively valued stimulus is
added to the situation, thus increasing the probality that
the behavior will occur
Negative reinforcement - behavior is strengthened by
the removal of an unpleasant or negatively valued
stimulus.