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Types of non-adherence and why patients don't adhere - Coggle Diagram
Types of non-adherence and why patients don't adhere
Type of non-adherence
Failure to change behaviour (changing diet)
Failure to attend medical appointments by missing appointments or not attending follow-up sessions
This can lead to
Increased mortality
Increased morbidity
Wasted money on pills or treatment sessions
No improvement in illness and more danger for other illnesses
Failure to follow treatment by not taking medication (pills)
Adherence - the extent to which a patient's behaviour and treatment coincides with the advice given by doctors
Non-adherence can be
During treatment
May take more or less of a prescribed drug
May not complete the prescription
May take the prescribed drug at a different time than instructed
End of treatment
May end the course of treatment early or not go to follow-up sessions
May relapse or go back to same bad behaviours
Before treatment
Lack of awareness of treatment due to poor description
Intentional - I forgot to take the pill
Unintentional - I'm not taking that pill
Patient
Patient decides that they don't need the treatment
Patient believes the costs or time of treatment are more than the benefit
Patient does not understand the treatment
Treatment programme
It is expensive
It is time consuming
It is difficult to administer
There may not be access to the treatment
Health care provider
Doctor does not stress the importance of the treatment
Doctor does not give adequate details about how to administer the drug
Rational Non-adherence (Bulpitt)
He explains that patients make a reasoned decision with a cost-benefit analysis
Bulpitt looked at the risks and benefits of a drug treatment for
hypertension (high blood pressure)
Risks included increased diabetes, gout, and dry mouth but these were either not
serious or at a very low rate.
Benefits included reduction in strokes by 40% and coronary events by 44%
People rationally decide not to take the medication because of the risks whilst ignoring the benefits.
The Health Belief Model
(Becker and Rosenstock)
It predicts that people will make health decisions rationally, based on the assumption that people are willing to change their behaviours depending on a number of factors.
Individual perceptions
Perceived vulnerability to health problem
perceived severity of health problem
Self-efficacy beliefs - if patients believe that they can be successful in changing their behaviour to benefit their health
Modifying factors
Culture
Educational levels
Perceived threat of health problem
Cues to action like advice from others or adverts
Perceived benefits of behaviour
Perceived barriers to behaviour
This can affect the likelihood of taking recommended preventive health actions
Compliance Model (Becker)
The compliance model considers negative aspects (perceived threat) and positive aspects (awareness of health problems) in the motivation to comply
Mother's psychological level of readiness to take the recommended health action
Child's vulnerability
Perceived efficacy of medicine
Mother's belief in diagnosis and treatment
Modifying factors
Demographic factors like race, age, ethnicity
Child's prior experience with that illness
Cues to action like advice from others and follow up appointments
Compliance
Likelihood of giving medication or taking appointments
Study
125 cases from a Comprehensive Child Care Clinic
All the children had to take liquid oral antibiotics and a follow-up visit.
Adherence was operationalised by asking the name of the medication, the number of times it should be taken, the date of the follow-up appointment
Results showed that mothers who were more concerned about their child's heath were more likely to adhere