Adherence to medical advice

What are the types of non adherence

Failure to follow treatments, Failure to attend appointments

Failure to follow treatment can be broken down into three different types

Primary non adherence, non- persistence, non conforming

What is rational non adherence

Rational non-adherence refers to the patient making a reasoned decision due to undertaking a cost-benefit analysis.  It seems too costly to adhere.  It is a complex interaction of a number of factors. A number of issues can be considered including the level of severity of the illness, side effects (both long and short-term), probability of cure / mortality in a certain number of years, cost, frequency or dose, interactions with other medicines or alcohol.

What is the Health Belief Model (HBM)?

The Health Belief Model predicts that individuals will make health decisions rationally, based on their perceptions of vulnerability, severity of health problems, and self-efficacy beliefs. It incorporates modifying factors such as culture, educational level, perceived benefits and barriers to behavior, along with perceived threats and cues to action. These elements interact to determine the likelihood of engaging in recommended preventive health actions.

Aim of Laba et al

to find out which factors contribute the most to rational non-adherence to investigate whether factors relating to specific medicines and patient background contribute to non-adherence.

Laba et al Result

Monthly cost was a significant factor but only for those without private medical insurance most participants (58%) considered harms to be of greater importance than benefits when making decisions about adherence.

What are the factors in the health blief model

Perceived severity, Perceived barriers, Cues to action, Self efficacy

What is the Health belief model and which 2 assesments does it make

This model aims to predict when a person will engage in preventative health measures such as changing their diet, stopping smoking, taking more exercise, attending screening, etc. The model suggest that this depends on TWO assessments that they will make: Evaluation of the threat, A cost-benefit analysis

Examples of Subjective measures in measuring non- adherence

Clinical interviews, Semi- structured interviews

Examples of objective measures in measuring non- adherence

Medical dispensers, Pill counting

Examples biological measures in measuring non- adherence

blood samples, urine samples

Which example study is mentioned in subjective measures of non- adherence

Which example study is mentioned in subjective measures of non- adherence

Which example study is mentioned in objective measures of non- adherence

Chung and Naya ( 2000)

What was the aim of Riekert and Drotar ( 1999)

• They wanted to examine the implications of non-participation in studies using selfreport.

What did Riekert and Drotar find

The families that returned their questionnaires had adolescents who had higher adherence interview scores and tested their bold sugar more frequently than families who did not return their questionnaires! This does demonstrate that those who take part in such self-report studies ARE more likely to be adherers and so distort this type of study.

What was the aim of Chung and Naya ( 2000)

This was the first study to electronically assess compliance with an oral asthma medication. Aimed to see if patients did take their medication regularly and at the correct time of day.

what did Chung and Naya find

the study showed that compliance was consistently high throughout the 12 weeks of treatment, and adherence, although slightly lower than compliance, was still good. The study also showed that, although compliance was measured higher by use of a tablet count than by the TrackCap, there was only a slight difference, so it can be concluded that the TrackCap is an accurate measure of compliance and adherence to medication.

What was the aim of the Yokley and Glenwick (1984) study?

To evaluate the effectiveness of four different conditions for motivating parents of preschool children to get their children immunised.

What was the sample population for the Yokley and Glenwick study?

The entire population of immunisation deficient preschool clients (aged five and under) at a public health clinic in an American city.

How many preschoolers were found to need at least one immunisation in the Yokley and Glenwick (1984) study?

1,133 preschoolers, which is 53.9% of the total 2,101.

What proportion of the sample were Caucasian children in the Yokley and Glenwick (1984) study ?

64% were Caucasian.

Describe the 'general prompt group' in the Yokley and Glenwick (1984) study.

Families were mailed a prompt with general immunisation information, urging parents to get their children's immunisations up to date, but without any specific or personal information.

Describe the 'specific prompt group' in the Yokley and Glenwick (1984) study.

Families were mailed a prompt that named the target child, listed the specific immunisations required, and included the clinic's location and hours.

What additional information did the 'increased access group' receive in the Yokley and Glenwick (1984) study?

They received the specific prompt along with extra out-of-hours sessions at the clinic, childcare facilities, and the option to leave children at free childcare.

What was offered to the 'monetary incentive group' in the Yokley and Glenwick (1984) study?

A specific prompt and information about a cash lottery with cash prize draws, requiring a ticket submission upon receiving the immunisation.

What were the control groups in the Yokley and Glenwick (1984) study?

The contact control group, who received a telephone contact without prompts, and the no-contact control group who received no contact during the study.

What were the control groups in the Yokley and Glenwick (1984) study?

The contact control group, who received a telephone contact without prompts, and the no-contact control group who received no contact during the study.

What were the dependent variables in the Yokley and Glenwick (1984) study?

Number of target children receiving one or more immunisations, number of target children attending the clinic for any reason, and total number of immunisations received by target children.

How did the monetary incentive group perform compared to other groups in the Yokley and Glenwick (1984) study?

The monetary incentive group had the biggest impact on immunisation rates.

What was the most cost-effective intervention according to the Yokley and Glenwick (1984) study?

The specific prompt was the most cost-effective intervention.

What does reductionism refer to

Understanding complex behaviours by breaking them into simpler factors or aspects, often without considering broader contexts.

What individual and situational factors may influence behaviour, according to the Yokley and Glenwick (1984) study?

Individual factors like personal traits and situational factors like environmental cues can explain behaviour.

How accurate were the specific prompts in the Yokley and Glenwick (1984) study?

93% of the specific prompts in a random sample of 10% were found to be completely accurate.

waht was Laba et al about

Factors contributing to rational non- adherence

What was the aim of the study by Yokley & Glenwick (1984)?

To evaluate the effectiveness of four different community interventions in motivating parents to immunize their preschool children.

How many children participated in Yokley & Glenwick's 1984 study?

2,101 immunization-deficient preschool children participated.

What was the average number of immunizations needed per child in the study?

The mean number of immunizations needed was 5.2 per child.

What types of interventions were used in the study?

General prompt, specific prompt, expanded clinic hours with free childcare, and a monetary incentive (cash lottery).

What did the 'general prompt' intervention involve?

It provided general immunization information and urged parents to get their children up to date on immunizations.

What did the 'specific prompt' intervention involve?

It named the target child, specified the required immunizations, and gave the clinic's location and hours.

What did the 'expanded hours' intervention involve?

It included the specific prompt, plus information about extra out-of-hours sessions and free childcare at the clinic.

What did the 'monetary incentive' intervention involve?

It provided the specific prompt plus entry into a cash lottery for parents when their child received immunizations.

What were the control groups in the study?

One control group received a phone call requesting information (contact control), and the second received no contact (no-contact control).

Which intervention had the greatest impact on increasing immunization rates?

The monetary incentive group had the biggest impact on immunization rates.

Which interventions produced a 29% increase in immunizations?

The specific prompt and monetary incentive interventions each produced a 29% increase.

Which intervention was considered most cost-effective?

The increased access (expanded hours with free childcare) intervention was considered the most cost-effective.

What major conclusion did the study draw for health departments?

The study suggested that community intervention programs can increase immunization rates and can be used effectively by health departments.

What are two strong features of the study's design?

Large-scale sample (2,101 children), longitudinal design with follow-up 2–3 months later.

Why is the validity and reliability of the prompts in this study considered high?

Prompt accuracy was high, and their delivery was consistent throughout the study.

What is one limitation regarding the generalizability of this study?

Results may not generalize beyond preschoolers aged 5 or under and other locations, since the study took place at a single urban American clinic.

What is a real-world application (RWA) of the study?

The findings can influence public health policy and the design of community health intervention programs.