Adhering to Medical AdviceAdhering to Medical Advice

Chap 4Chap 4

Theories that Apply to AdherenceTheories that Apply to Adherence

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

Table 4.2Table 4.2Reasons Given by Patients for Not Complying Reasons Given by Patients for Not Complying

with Medical Advicewith Medical Advice

Table 4.1aTable 4.1aPredictors of Patient AdherencePredictors of Patient Adherence

Table 4.1dTable 4.1d

Table 4.1bTable 4.1b

Table 4.1cTable 4.1c

Behavioral Theory Behavioral Theory

The behavioral model of adherence is based on principles of The behavioral model of adherence is based on principles of operant conditioning, especially positive and negative operant conditioning, especially positive and negative reinforcement. reinforcement.

With With positive reinforcementpositive reinforcement, a positively valued stimulus is added , a positively valued stimulus is added to the situation, thus strengthening that behavior and increasing the to the situation, thus strengthening that behavior and increasing the probability that it will recur. probability that it will recur.

Behavioral Theory Behavioral Theory

With With negative reinforcementnegative reinforcement, behavior is , behavior is strengthened by the removal of an unpleasant or strengthened by the removal of an unpleasant or negatively valued stimulus. Both types of negatively valued stimulus. Both types of reinforcers reinforcers strengthenstrengthen behavior, whereas behavior, whereas punishmentpunishment inhibits or suppresses behavior. inhibits or suppresses behavior.

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

  

Behavioral Theory Behavioral Theory

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

Self-Efficacy TheorySelf-Efficacy Theory

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

Self-Efficacy TheorySelf-Efficacy Theory

An important component of the person factor is An important component of the person factor is self-efficacyself-efficacy, or people's belief that they have , or people's belief that they have the ability to perform the ability to perform specificspecific behaviors that will behaviors that will lead to desired consequences. lead to desired consequences. For example, self-efficacy was the best For example, self-efficacy was the best

predictor of adherence to an exercise predictor of adherence to an exercise rehabilitation program. rehabilitation program.

Research has generally supported the Research has generally supported the importance of self-efficacy in health-related importance of self-efficacy in health-related behaviors, especially the two difficult behaviors, especially the two difficult behaviors of diet and smoking cessation.behaviors of diet and smoking cessation.

Theories of Reasoned Action and Planned Theories of Reasoned Action and Planned BehaviorBehavior

Ajzen and Fishbein'sAjzen and Fishbein's theory of reasoned action theory of reasoned action and Ajzen's and Ajzen's theory theory of planned behavior of planned behavior both assume that the immediate determiner of both assume that the immediate determiner of behavior is people's behavior is people's intentionintention to perform that behavior. to perform that behavior.

The theory of reasoned action suggests that behavioral intentions, The theory of reasoned action suggests that behavioral intentions, in turn, are in turn, are

Theories of Reasoned Action and Planned Theories of Reasoned Action and Planned BehaviorBehavior

(1) a function of people's(1) a function of people's attitudes attitudes toward the toward the behavior, which are determined by their beliefs behavior, which are determined by their beliefs that the behavior will lead to positively or that the behavior will lead to positively or negatively valued outcomes, and negatively valued outcomes, and

(2) their (2) their subjective normsubjective norm, which is shaped by , which is shaped by their perception of the value that significant their perception of the value that significant others place on that behavior and by their others place on that behavior and by their motivation motivation to comply with those norms (to comply with those norms (seesee Chapter 3, Figure 3.1). Chapter 3, Figure 3.1).

Theories of Reasoned Action and Planned Theories of Reasoned Action and Planned BehaviorBehavior

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

Theories of Reasoned Action and Planned Theories of Reasoned Action and Planned BehaviorBehavior

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

The Transtheoretical ModelThe Transtheoretical Model

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

The Transtheoretical ModelThe Transtheoretical Model

The The precontemplation stage precontemplation stage precedes intention precedes intention to change behavior, and people in this stage to change behavior, and people in this stage may fail to see that they have a problem.may fail to see that they have a problem.

The The contemplation stagecontemplation stage involves awareness of involves awareness of the problem and thoughts about changing the problem and thoughts about changing behavior, but the person has not yet made an behavior, but the person has not yet made an effort to change.effort to change.

The Transtheoretical ModelThe Transtheoretical Model

The The preparation stage preparation stage includes both thoughts includes both thoughts and action, with people in this stage making and action, with people in this stage making specific plans about change. The modification of specific plans about change. The modification of behavior comes in the behavior comes in the action stageaction stage, when , when people make overt changes in their behavior.people make overt changes in their behavior.

During the During the maintenance stage maintenance stage people try to people try to sustain the changes they have made and to sustain the changes they have made and to resist temptation to relapse (resist temptation to relapse (seesee Figure 4.2). Figure 4.2). People in these various stages need different People in these various stages need different types of assistance in making changes. types of assistance in making changes. Research on this theory has indicated that these Research on this theory has indicated that these stages of change apply to a variety of health-stages of change apply to a variety of health-related behaviors.related behaviors.

Figure 4.2Figure 4.2The transtheoretical model and stages of The transtheoretical model and stages of

changing from a high-fat diet to a low-fat diet.changing from a high-fat diet to a low-fat diet.