Healthy living psychology: measuring adherence (concept)

Types of request:

One of the issues to consider with adherence is the type of behaviour we are asking someone to follow. Requests for health adherence can usually be discussed with the friends and family of the participant as well.

types of health request fall into a number of categories:

1. requests for short-term adherence with simple treatments, e.g. 'take these tablets twice a day for three weeks.'
2. Requests for positive addictions to lifestyle, e.g. 'eat more vegetables and do more exercise'
3. Requests to stop certain behaviours e.g. 'stop smoking'
4. Requests for long-term treatments regimes, for example sticking to a diabetic diet, or the diet prescribed for people undergoing renal dialysis.

a cursory look at these types of request reveals some striking differences, and suggests that the problems of adherence might be different for the different types of medical request. e.g. short term treatments or alot easier to follow than long term ones which can greatly change there life and make them feel uncomfortable such as not being able to go out to the pub with friends which greatly increases the barriers, alot more than the short term requirements.There is too much simplification within adherence and there is very different reasons for non adherence for each category.

When we look at studies on adherence there are two reasons for thinking that the estimates of adherence may be a bit optimistic. 

• The first problem is the selection of people to take part in the studies. e.g. a lot may of the same personal variables such as economic status or age and also people with low adherence may not answer to a self report because they are unconfident whereas high adherence ones would not care. 
• The other problem with adherence research is that people wont always tell the truth. one of the reasons for this is to present a good impression to health workers.This can be very important, since the patient might well believe that they will only receive the best treatment if the health staff believe that they are carrying out their instructions. An extreme example is of smokers who have been refused treatment if they admitted that they were still smoking (social desirability bias).

Implication for improving adherence

Measurement techniques

It is important to develop reliable ways of measuring adherence and the following methods can be used:

1. Self Report: Ask the patient ans they may tell you how adherent they have been- studies have shown they seriously over estimate there adherence when compared to medical records.
2. Therapeutic outcome: Is the patient getting better? for example is the patient is taking medication for hypertension then we would expect there heart rate to decrease however there may be a range of other factors involved so its reductionist.
3. Health worker estimates : ask a doctor and they should be able to estimate how adherent a patient is being, this has been to be highly unreliable and subjective.
4. Pill and bottle counts: If we count the number of pills left in the bottle and compare it with the number that should be there and we get a measure of adherence. Problem with this method is the patient may throw the pills away.
5. Mechanical methods: A number of devices have been developed to measure how much medicine is dispensed from a bottle, These devices are expensive and they only measure how much medicine goes out the bottle, not into the participant
6. Biochemical tests: It is possible to use blood tests or urine tests to estimate how adherent a patient has been with their medication. For example, it is possible to estimate adherence with diet in renal patients by measuring the levels of potassium and urea in their blood when they report for their next session of dialysis.

Overall, we can use a wide variety of methods to investigate patient adherence, but like all methods in psychology, they only produce estimates of behaviour, and they all contain some degree of error. A treatment that is growing in the UK is oral asthma medication, and measuring adherence rates will help us to measure the effectiveness of the medicines. If people follow the prescribed treatment programme they should reduce the attacks of breathlessness, but many people forget or decline to take the medication regularly. A study by chung and naya was done into this and this is explained in the next post