Reasons for nonadh & methods improv nonad

• Maintenance of behavioural change: stress- can affect non ad in 4 diff ways

  • Poverty- non adherence worse in socioeconomic groups (eg for diabetes medication)
  • Chaotic lifestyles-disorganised=stressful. People often forget to take med or find it hard to follow med advice (cannot schedule exercise or relaxation)
  • Stressed clients=anxious, attention becomes narrower. When speaking to professionals latch onto words and ignore rest. E.g: Cancer. Other ignored info might concern follow up appointments and medication, making adherence unlikely
  • Memory
• Strengths:

  Research support: Hamidreza Roohafza et al (2016) studied almost 10,000 clients with diabetes and/or hypertension (high blood pressure). Found that clients experiencing the highest levels of stress were on adherent to medication and/or exercise advice. Supports view that stress can increase non adherence risk even in life threatening disorders
• Weakness

  Long-term effects of stress on non adherence are unclear. E.g: studies tend to look at short term effects, unclear how non adherence changes over time with stress levels.
• Rational non-adherence: Cost-benefit analysis

  Clients may make deliberate decision to follow or not follow med advice after weighing up costs and benefits. Main benefit of taking prescribed med is that it will reduce or eliminate symptoms of illness or injury
• Rational non-adherence: what are the 3 main costs

  • Side effects: Dizziness, stomach problems, sexual difficulties and memory problems
  • Financial barriers: Some people dont adhere to med advice because they cannot afford to. Less of an issue in countries with a healthcare system. (NHS). People with priv med insurance that covers treatment are more likely to adhere to med because cost doesnt matter
  • Patient-practitioner relationship: Level of trust, "prac centred approach", prac has all power. Lead non adherence rather than friendly and personal
• Strengths

  Research confirms influence of rational factors. Researcher studied what happened in spain when older clients had to start paying share of med costs in 2012. Adherence declined for expensive drugs. Shows non adherence is increased by financial barriers, suggesting it has rational basis
• Weakness

  Unjustified assumption- approach based on innaccurate view of clients. Assumes that client has weighed up costs and benefits of following med advice in a cool and calm way before making a decision. Many decisions however, are made without a plan, and clients current stressful situation is often more important than cost-benefit analysis. Suggests non adherence as a rational process cannot explain all health related decision making
• Learned helplessness:

  Downward spiral- Someone experiencing learned helplessness may well become depressed, so depression itself makes non-adherence more likely. Non-adherence makes depression worse and reinforces learned helplessness, which makes non adherence more likely- so client is trapped in downward spiral.
• Lack of support: Significant others

  • Without a social network- a person may have no one to remind them to take medication, take them to appointments, show them how to access exercise videos etc
  • Lack of emotional support- adherence less likely when client lacks people who can help improve their mood, or who can provide encouragement, rewards, a 'shoulder to cry on'. However, relationships with significant others can be negative. Lack of such support may produce better outcomes for someone who need to follow med advice because they rely more on support from prof
• Lack of support: Health professionals


  Lack of prac support- Main type of support usually provided by health professionals is informational. Health professionals are experts on the benefits of adherence, so lack of info from them can lead to non-adherence

  Lack of emotional support- clients usually expect prof to provide emotional support as well. Most consider this their role, might be a gap between amount of support clients expect and prof provide. Key factor is how client perceives support. Where client feels that they dont trust prof or that communication is poor, will perceive lack of sup
• Methods to improve adherence- 1. Health education and promotion


  Improving access to information

  • Discussions w health prof are still key source of info and appointments can be made via apps and can take place virtually
  • Pharmacists become more accessible sources of info, because they are present on many high streets and appointments are not usually necessary
  • Telephone follow-ups to discussions are common and give clients chance to ask questions that they may not have considered during face-to face consultation