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

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Lecture 12: Adherence and Resistance (Medicine Taking)
- 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
- Will be like the midterm (same format)
- Covering material starting from today
- 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
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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
• 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
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)
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
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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