PSYC 3110 Lecture Notes - Lecture 12: Social Learning Theory, Social Cognition, Grandparent

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Lecture 12: Adherence and Resistance (Medicine Taking)
Notes
- Excellent time to do background reading for essay
- Have to answer essay question and come up with an argument
- Need to say this is the position I am going to be advocating and have to find evidence to
support that view
- You should make a case in your essay
Final
- Will be like the midterm (same format)
- Covering material starting from today
Adherence
- We are talking about medicine
- Getting prescribed a particular medication (you can do a number of different things)
Take medicines as prescribed (take medication and with food)
Don’t get the prescription
– Don’t take correct dosage
Don’t take at correct times (do everything but take at incorrect time: if you are told to
take at breakfast every morning and you don’t)
Stop medicine before course is completed (you can do everything correctly but
instead of taking it for a month take for a week
- Non adherence is not following advice
- 3 words (Compliance, adherence and concordance)
- Compliance: You will do something. People don’t like compliance.
- Adherence: Adherence a softer version of compliance. Given advice do people follow?
- Concordance: More of an equal relationship. Conceptualized as an equal relationship
with doctor and patient.
Extent (Wertheimer & Santella)
- What is the nature of the problem?
- Who is it a problem for?
- Talking about non adherence
- Non adherence depends on medications
• Varies across medication related behaviour
• In general, 50-75% don’t follow directives
14-21% don’t fill prescriptions (don’t get prescription)
60% can’t identify own medication
30-50% ignore medical instructions
– 12-20% take other people’s medication
Consequences
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• US (Wertheimer & Santella), annually:
125,000 die of inappropriate medication use
1⁄4 nursing home admission due to inappropriate medication use
Hospital costs due to non-adherence $8.5 billion
- Based on these metrics non-adherence is an issue
• Vermeire et al.
Extensive review of literature
Note insufficient focus on patient perspective
1. Factors associated with non-adherence
- A lot of research has tried to focus on the factors that is associated with this problem
- Dependent variable is non-adherence (not following the advice)
- Want to know independent variables (what are the factors influencing that behaviour)
• Patient characteristics (is there something about people that makes them non-adherent)
• Disease characteristics (could it be something about medication)
• Treatment factors (could it be something about the treatment, too difficult to do)
• Interpersonal factors (something about relationship between patient and medical
professional
• Social and organisational setting
The “non-adherent” Patient
o In general, less social support, more socially isolated, more likely non-adherence 
o No luck identifying specific personality 
o Health Belief Model
Focus on; perceived severity, susceptibility, benefits & barriers 
o Social Learning Theory 
Focus on locus of control& self-efficacy 
o Criticisms of SCMs: 
Empirical: only small variance of adherence explained
Theoretical: behaviour abstracted from context in which it occurs 
o Social context
Patient literacy, self-efficacy 
- Problem is the non-adherent issue
- What is it about the non-adherent patient that makes them on adherent
- On average they have these characteristics
- There are two key criticisms of social cognition models (on an empirical level it only
explains small amount of variance, which means that there are other factors that are more
important)
o On a theoretical level the adherence is abstracted from the context in which it occurs
(Reading for today talks about this)
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Influence of the Disease
• Lower adherence with asymptomatic chronic disease
- Difficult to see how medication might help
• More likely with obvious symptoms
• Lower adherence when prognosis is poor (prognosis doesn’t look good for you)
Treatment
o Various factors influence non-adherence 
o More complicated treatments, less adherence
o Longer treatments, lower adherence
- Takes a lot of cognitive energy
o Character of treatment (e.g., inhaled for asthma) 
- Is it an injection, a pill, inhaler?
- The more something is unpleasant the more likely they won’t do it
Interpersonal Factors
• Nature of physician-patient relationship
• Patients generally prefer patient-centred style; also more adherence
• Meta-analysis of patient satisfaction
Interpersonal competence; social conversation; better communication; more
information; technical competence
- In general on average, patients tend to prefer patient-centred styles
- Meta-analysis shows that satisfaction comes more when more information is provided
etc.
Interpersonal Factors (2)
o Association between physician job satisfaction and aspects of adherence 
o Different views of health and illness (St. Claire et al) – Physician: absence of
disease– Patient: ‘being able’, ‘taking action’, ‘physical well being’ Also
cultural perspectives 
- For example, in ore extreme cases a biomedical view in a physician, for patients
health might be more about action and overall physical well-being, when there is a
discrepancy more likely to lead to non-adherence
o The more understanding physician is of patient’s view, the more adherence
- There are also cultural factors
Interpersonal Factors (3)
• Physician’s view of patient
- We do know from research doctor’s have particular views about certain groups
- For instance, racist attitudes, attitudes towards smokers (Can have an impact)
• More positive view leads to more affiliative communication style
Fits with observed effect that upper and middle class patients receive more attention
and info
• Tactile contact (Gueguen & Vion)
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