Adhering to Medical Advice Chap 4

Theories that Apply to Adherence Why do people fail to follow the advice of a health care provider? Several theoretical models that apply to behavior in general have also been applied to the problem of adherence and nonadherence. Why do people fail to follow the advice of a health care provider? Several theoretical models that apply to behavior in general have also been applied to the problem of adherence and nonadherence.

Table 4.2 Reasons Given by Patients for Not Complying with Medical Advice

Table 4.1a Predictors of Patient Adherence

Table 4.1d

Table 4.1b

Table 4.1c

Behavioral Theory The behavioral model of adherence is based on principles of operant conditioning, especially positive and negative reinforcement. The behavioral model of adherence is based on principles of operant conditioning, especially positive and negative reinforcement. With positive reinforcement, a positively valued stimulus is added to the situation, thus strengthening that behavior and increasing the probability that it will recur. With positive reinforcement, a positively valued stimulus is added to the situation, thus strengthening that behavior and increasing the probability that it will recur.

Behavioral Theory With negative reinforcement, behavior is strengthened by the removal of an unpleasant or negatively valued stimulus. Both types of reinforcers strengthen behavior, whereas punishment inhibits or suppresses behavior. With negative reinforcement, behavior is strengthened by the removal of an unpleasant or negatively valued stimulus. Both types of reinforcers strengthen behavior, whereas punishment inhibits or suppresses behavior. Advocates of the behavioral model use cues, rewards, and contracts to reinforce compliant behaviors. Some research supports the effectiveness of this approach. Advocates of the behavioral model use cues, rewards, and contracts to reinforce compliant behaviors. Some research supports the effectiveness of this approach.

Behavioral Theory Advocates of the behavioral model use cues, rewards, and contracts to reinforce compliant behaviors. Some research supports the effectiveness of this approach. Advocates of the behavioral model use cues, rewards, and contracts to reinforce compliant behaviors. Some research supports the effectiveness of this approach.

Self-Efficacy Theory Bandura's social cognitive theory is a general theory of behavior that stresses the interaction of behavior, environment, and person factors, especially cognition. Bandura used the term reciprocal determinism to describe this model (see Figure 4.1). Bandura's social cognitive theory is a general theory of behavior that stresses the interaction of behavior, environment, and person factors, especially cognition. Bandura used the term reciprocal determinism to describe this model (see Figure 4.1).

Self-Efficacy Theory An important component of the person factor is self-efficacy, or people's belief that they have the ability to perform specific behaviors that will lead to desired consequences. An important component of the person factor is self-efficacy, or people's belief that they have the ability to perform specific behaviors that will lead to desired consequences. For example, self-efficacy was the best predictor of adherence to an exercise rehabilitation program. For example, self-efficacy was the best predictor of adherence to an exercise rehabilitation program. Research has generally supported the importance of self-efficacy in health-related behaviors, especially the two difficult behaviors of diet and smoking cessation. Research has generally supported the importance of self-efficacy in health-related behaviors, especially the two difficult behaviors of diet and smoking cessation.

Theories of Reasoned Action and Planned Behavior Ajzen and Fishbein's theory of reasoned action and Ajzen's theory of planned behavior both assume that the immediate determiner of behavior is people's intention to perform that behavior. Ajzen and Fishbein's theory of reasoned action and Ajzen's theory of planned behavior both assume that the immediate determiner of behavior is people's intention to perform that behavior. The theory of reasoned action suggests that behavioral intentions, in turn, are The theory of reasoned action suggests that behavioral intentions, in turn, are

Theories of Reasoned Action and Planned Behavior (1) a function of people's attitudes toward the behavior, which are determined by their beliefs that the behavior will lead to positively or negatively valued outcomes, and (1) a function of people's attitudes toward the behavior, which are determined by their beliefs that the behavior will lead to positively or negatively valued outcomes, and (2) their subjective norm, which is shaped by their perception of the value that significant others place on that behavior and by their motivation to comply with those norms (see Chapter 3, Figure 3.1). (2) their subjective norm, which is shaped by their perception of the value that significant others place on that behavior and by their motivation to comply with those norms (see Chapter 3, Figure 3.1).

Theories of Reasoned Action and Planned Behavior The theory of planned behavior includes an additional determinant of intentions to act, namely, people's perception of how much control they have over their behavior (see Chapter 3, Figure 3.2). Both theories have been used to predict adherence to a number of health-related behaviors. The theory of planned behavior includes an additional determinant of intentions to act, namely, people's perception of how much control they have over their behavior (see Chapter 3, Figure 3.2). Both theories have been used to predict adherence to a number of health-related behaviors.

Theories of Reasoned Action and Planned Behavior A meta-analysis of studies on the usefulness of the theory of reasoned action and the theory of planned behavior found that both theories had some value in predicting who will adhere to an exercise program and who will not, but these theories are only modestly successful A meta-analysis of studies on the usefulness of the theory of reasoned action and the theory of planned behavior found that both theories had some value in predicting who will adhere to an exercise program and who will not, but these theories are only modestly successful

The Transtheoretical Model The transtheoretical model of James Prochaska and his colleagues assumes that people progress through five stages in making changes in behavior—precontemplation, contemplation, preparation, action, and maintenance. The transtheoretical model of James Prochaska and his colleagues assumes that people progress through five stages in making changes in behavior—precontemplation, contemplation, preparation, action, and maintenance.

The Transtheoretical Model The precontemplation stage precedes intention to change behavior, and people in this stage may fail to see that they have a problem. The precontemplation stage precedes intention to change behavior, and people in this stage may fail to see that they have a problem. The contemplation stage involves awareness of the problem and thoughts about changing behavior, but the person has not yet made an effort to change. The contemplation stage involves awareness of the problem and thoughts about changing behavior, but the person has not yet made an effort to change.

The Transtheoretical Model The preparation stage includes both thoughts and action, with people in this stage making specific plans about change. The modification of behavior comes in the action stage, when people make overt changes in their behavior. The preparation stage includes both thoughts and action, with people in this stage making specific plans about change. The modification of behavior comes in the action stage, when people make overt changes in their behavior. During the maintenance stage people try to sustain the changes they have made and to resist temptation to relapse (see Figure 4.2). People in these various stages need different types of assistance in making changes. Research on this theory has indicated that these stages of change apply to a variety of health- related behaviors. During the maintenance stage people try to sustain the changes they have made and to resist temptation to relapse (see Figure 4.2). People in these various stages need different types of assistance in making changes. Research on this theory has indicated that these stages of change apply to a variety of health- related behaviors.

Figure 4.2 The transtheoretical model and stages of changing from a high-fat diet to a low-fat diet.