Adherence in Pediatric Psychology - Public Health and Psychology - Lecture Slides, Slides of Public Health

Download Adherence in Pediatric Psychology - Public Health and Psychology - Lecture Slides and more Slides Public Health in PDF only on Docsity! Adherence in Pediatric Psychology Docsity.com What is adherence?  “the extent to which a person’s behavior (in terms of taking medications, following diets, or executing life style changes) coincides with medical or health advice” (Haynes, 1979, pp 2-3)  “a person’s behavior in relation to a prescribed medical regimen” (La Greca & Bearman, 2003) Docsity.com Theories of Adherence  Transtheoretical Model (Stages of Change)  Five stages in the adoption of health-related behaviors: • Precontemplation • Contemplation • Preparation • Action • Maintenance  Match intervention to stage  Very difficult to apply to pediatric conditions! Docsity.com Theories of Adherence  Health Belief Model  Can be applied to preventative treatments  Views patients as autonomous “decision makers”  Considers the patient’s perceptions of: • Threat of illness • Effectiveness of treatment • Barriers to treatment  Again, difficult to apply to pediatric conditions! Docsity.com Measuring Adherence  Categorical approach with adherence as a unitary construct • adherent, nonadherent, or good, moderate, poor  Multidimensional, continuous construct • Use multiple behaviors as indicators • Assess adherence along a continuum Docsity.com Measuring Adherence  Electronic monitoring devices • MEMS caps, blood glucose monitors, vests for CF  Lab assays • blood, urine, etc. tests • used mainly for medication adherence  Health status indicators • biological measures of disease status • pulmonary function tests, HgbA1c Docsity.com Health Status & Adherence  Health status and adherence are not interchangeable terms  Health status measures are widely used by medical providers because they have been linked to long-term outcomes of morbidity and mortality  Most medical providers (and psychologists, too!) infer than health status = adherence Docsity.com Health Status & Heath Behavior Behavior Health Status Good Poor Good Poor Johnson, 1994 Docsity.com Health Status & Adherence: Importance of Tx Effectiveness Strong Tx Weak Tx Inert Tx Adherence Poor Good Health Status Poor Good Docsity.com Nonadherence: The norm rather than the exception  “ . . . patients do not fail to comply, rather, they choose another course of behavior. The doctor’s advice is just one input among many in how to handle health and illness. Providers may consider the decisions that patients make irrational, but they may be quite rational from the patients’ perspective.” (Bauman, 2004)  10,000 journal articles on adherence—yet, rates of nonadherence remain high  “adaptive noncompliance” (La Greca & Bearman, 2003) Docsity.com Prevalence of Nonadherence  Nonadherence occurs regardless of age, race, gender, and disease  In pediatric populations, nonadherence is estimated at 50%  Rates are higher for chronic conditions  Adherence declines over time  Adolescents are generally less adherent than younger children Docsity.com Risk Factors for Inadvertent Nonadherence 1. Patient characteristics  Intellectual functioning, memory, stress, lack of resources, lack of social support, disease knowledge 2. Developmental considerations  Medication refusal  Cognitive abilities of children  Adolescents’ independence/autonomy Docsity.com Risk Factors for Inadvertent Nonadherence 3. Provider/System characteristics • Poor patient-provider communication • Lack of patient education • Long waiting times, geographic distance, unfriendly staff 4. Regimen characteristics • Complexity • Frequency of regimen-drift over time Docsity.com Special Considerations for Pediatric Patients  Barriers can exist for the parent and the child  Importance of family interactions  Developmental issues: • Toddlers—may be oppositional with painful procedures, bad tasting meds, activity restrictions • School-aged—may not adhere if they are teased at school • Adolescents—may experiment with meds to exert control, struggle for independence from parents Docsity.com Adherence Interventions  Types of interventions:  Educational approaches  Behavioral approaches • Medical supervision/monitoring • Visual cues and reminders • Self-monitoring • Reinforcement  Family Interventions Docsity.com Adherence Interventions  Peer interventions  Barrier reduction?  Multicomponent interventions  “Self Management Training” Docsity.com