Improving adherence.

1. Improving adherence. • Provide more information about the drugs and the treatment. • Tailored regimens are easier to comply with, and there has been some encouraging results (e.g. Haynes et al, 1979). • Get the doctor to improve communication and to be warm and sensitive.

2. Get the patients to ask more questions so that they get more information. • This will help to prevent false beliefs. • It also improves patient satisfaction with the doctor, and thus compliance. • Some patients may not know what to do if they miss taking some tablets. • Others may not know when they could expect to feel better.

3. Ley et al 1976 • Three different types of leaflets were given to patients. • One was easy to understand, another was moderately difficult and the other was very difficult to understand. • Compliance increased for those patients who were given easy or moderately difficult leaflets (Ley et al 1976).

4. (Belisle et al, 1987). • Just informing patients about their illnesses will not necessarily increase compliance. • Patients suffering from hypertension viewed a slide show and read a booklet about hypertension and its treatment, emphasising the benefits of treatment and regular medication.

5. (Belisle et al, 1987). • Despite this greater understanding there were no differences in compliance or effectiveness of blood pressure control between patients who had and had not been given the educational program. • However, programs that provide information about the problems people will face in trying to adhere to a regimen and focus on changing peoples interpretation of their relapses have been more successful in promoting compliance (Belisle et al, 1987).

6. Increase the frequency of visits to the doctors. This would increase positive reinforcement. • The patient would comply because they would not wish to be scolded by the doctor. • Some studies have found compliance to increase by up to 60 percent (e.g. McKenny et al., 1973).

7. When supervision is reduced, so is compliance. • For example, non-compliant hypertensive patients were asked to keep a record of their blood pressure and compliance was increased as a result. • This only happened when the records were checked on a regular basis.

8. Nessman et al (1980) • Nessman et al (1980) group sessions are more effective. • In this experiment the treatment was for hypertension (high blood pressure). • Compliance increased from 38% to 88%.

9. Nessman et al (1980) • The result could be misleading because the researchers were only able to persuade 56 people out of a possible 500, to take part! • They could have been highly motivated from the start!

10. information sheets and treatment programmes • One factor that might improve adherence is designing information sheets and treatment programmes that are easy to understand and carry out. • An important aspect of this is to consider the special needs of different client groups.

11. information sheets and treatment programmes • Old people, for example, often have different understandings and health beliefs to young people.

12. information sheets and treatment programmes • Kaplan et aI. (1993) identifies three problems for old people in following treatment programmes: • i) Some old people have difficulty understanding and following complex instructions. Although ageing is not necessarily related to mental decline, some old people develop cognitive problems, such as memory loss, which make it more difficult to follow treatment programmes. • ii) Older people sometimes have difficulty with medicine containers because they lack the manual dexterity to deal with childproof caps. It has been noted that older people sometimes get over this problem by transferring the tablets to other containers, and this can lead to confusion about which tablet is which.

13. information sheets and treatment programmes • iii) Older people are sometimes on a range of medications for different conditions and these might be prescribed by different doctors. This increases the risks of unpleasant side-effects, and so increases the chance that the patient will decide to discontinue the treatment.

14. Improving communication • (Sarafino 1994). • Simple verbal instructions, simple language (no jargon). • Give specific instructions, not general ones. • Emphasise key information.

15. Improving communication 4 Give simple written instructions. 5 Get the patient to repeat the instructions in their own words. 6 Break down the information into stages. get the patient to follow a simple regimen at first, and then add to this later.

16. (Haynes, 1982). • This will help for short-term regimens more than long-term (Haynes, 1982).

17. Kulik and Carlino (1987) • Kulik and Carlino (1987) found that by getting children to promise to take the medicine, significantly more children complied as ascertained by urine samples and interviews with parents. • Control children were told to take the medicine, but the doctor did not ask the child to promise.

18. Kulik and Carlino (1987) • The children were randomly allocated to the two groups. • The children were followed up 10 days later.

19. The health worker • The health worker has a central role. • They can tailor the message to the individual lifestyle of the patient. • Face to face contact will increase co-operation. • Can get other family members to help out. • Progress can be monitored.

20. Behavioural methods • feedback - regular reports can reinforce compliant behaviour. • Self-monitoring - patient keeps a written record. • Tailoring the regime - fitting in the treatment with the patients lifestyle.

21. Behavioural methods 4 Increasing sense of control. 5 Prompts and reminders - using alarm settings on a watch or telephone calls to remind patients. 6 Contingency contract - goals and rewards negotiated with health worker.

22. Behavioural methods 7 Modelling - patient can see other patients successfully following their treatment. • Major advantage is that patients can become involved in their treatment (Turk & Meichenbaum, 1991).