Adherence to Medical Regimens October 31, 2007

Defining Adherence Categorical approach Formula approach Uses cutoff scores to classify Formula approach Combines multiple indicators or adherence Then categorizes patients Continuum approach Focuses on “behavior,” not “patient” Computes adherence rates for various health care behaviors

Methods for Measuring Adherence Health status Drug assays

Methods for Measuring Adherence Self-report Most frequently used Tend to overestimate Ratings by health care professionals Often based on info given by patient Potential for bias Health status may be used as an indicator

Methods for Measuring Adherence Behavioral observations Pill counts Monitoring devices

Factors Affecting Adherence Child characteristics Family system Medical system Disease & regiment considerations

Child characteristics Developmental status Cognitive Social-emotional Physical Emotional functioning Biological functioning

Family System Parental involvement Parental knowledge & problem solving skills Parental support Stress & conflict

Medical System Doctor-patient relationship Contextual aspects of medical setting Provider communication

Disease & Regimen Characteristics Chronicity Complexity Immediate & future consequences of adherence

Health Belief Model Susceptibility to a particular illness Severity or seriousness of the disease & its complications Benefits of prescribed health care actions Barriers to health care

Transtheoretical Model Precontemplation Contemplation Preparation Action Maintenance

Transtheoretical Model Decisional balance Self-efficacy

Problems in Intervention Research Small sample sizes Brief treatment durations & follow-up periods Combined treatment strategies Failure to match treatments to patient experience Homogeneous samples

Interventions Educational approaches Modeling Supervision by health care professionals

Interventions Visual cues or reminders Self-monitoring Incentives

Interventions Social support Reducing barriers & problem-solving