1. Adherence to Medical Regimens
October 31, 2007

2. 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

3. Methods for Measuring Adherence
Health status
Drug assays

4. 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

5. Methods for Measuring Adherence
Behavioral observations
Pill counts
Monitoring devices

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

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

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

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

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

12. 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

13. Transtheoretical Model
Precontemplation
Contemplation
Preparation
Action
Maintenance

14. Transtheoretical Model
Decisional balance
Self-efficacy

15. 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

16. Interventions Educational approaches Modeling
Supervision by health care professionals

17. Interventions
Visual cues or reminders
Self-monitoring
Incentives

18. Interventions
Social support
Reducing barriers & problem-solving