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Principle Set #3 : The “if” of voice training and therapy: Factors affecting compliance

Principle Set #3 : The “if” of voice training and therapy: Factors affecting compliance. Kittie Verdolini Abbott, PhD, CCC-SLP; 2011. Communication Science and Disorders School of Health and Rehabilitation Sciences. Compliance.

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Principle Set #3 : The “if” of voice training and therapy: Factors affecting compliance

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  1. Principle Set #3:The “if” of voice training and therapy: Factors affecting compliance Kittie Verdolini Abbott, PhD, CCC-SLP; 2011 Communication Science and Disorders School of Health and Rehabilitation Sciences

  2. Compliance • Defined: Extent to which patients implement health care instructions • Aspects: • Seeking treatment • Behavior in health care setting • Following recommendations after visit • Follow-up visits icardia.com

  3. Terminology is problematic • Compliance implies hierarchical (condescending) health care model; passive patient • Alternative terms • Adherence improves little to my thinking, but is widely used • Concordance model of health care (Bissell et al., 1997): Collaboration of pt and dr; at least in the past met resistance in practice (Bissell & Noyce, 1997)

  4. Measurement is problematic • Patients are often unreliable reporters • Physicians may overestimate (e.g. Gatchel & Baum, 1983) • Clinical outcome is not good indicator • Pharmacy refill info may be unreliable • Blood or urine assay may be best for pharmaceutical Rx, but not perfect due to different pt responses (Gatchel & Baum, 1983)

  5. Measurement updates • Electronic monitoring increasingly used effectively • E.g., compliance with isolation precautions (Ross et al., 2011) • E.g., compliance with voice therapy exercises (Doyle, personal communication; Nanjundeswaran et al., in preparation; Verdolini Abbott et al., in preparation) techfresh.net teenagelifestyle.com

  6. Factors affecting compliance DISEASE FACTORS Severity of health condition • Pt’s perception of severity increases compliance • Meds post stroke (Sappok et al., 2001) • CPAP for sleep apnea (Hui et al., 2001) • Incontinence treatments in women (Alewijnse et al., 2001) • Psychological treatment for insomnia (Morgan et al., 2003)

  7. Factors affecting compliance • Severity, cont’d • Rosenstock’s Health Belief Model (1974): Therapeutic action is related to four or more factors: • Susceptibility to disease • Perception of disease severity • Benefits of treatment • Barriers to treatment currentnursing.com

  8. Factors affecting compliance • Relevance for voice therapy?

  9. Factors affecting compliance DISEASE FACTORS Duration of illness • In some studies, negative relation to compliance • E.g. anorexia (Kahn & Pike, 2001) • Discussion? Why? http://www.helpfulhealthtips.com/wp-content/uploads/2008/04/Anorexia-Nervosa-2.jpg

  10. Factors affecting compliance PATIENT VARIABLES Demographic factors • Gender: No effect or males have an edge (Kittler, Weitzdorfer, Pehamberger, Wolff, & Binder, 2001; Maviglia, Teich, Fiskio, & Bates, 2001; Salmon, 2001) • Age: Varies across Dx (e.g. Maviglia et al., 2001; Gordillo et al., 1999; Kiortsis et al., 2000). • Race and ethnic group: Variable findings • When income and education was controlled, race did not emerge as a risk factor for mammography utilization (Rawl et al., 2000).

  11. Aside • Googled “guy” • fh.huji.ac.il Dr. Guy Ashkenazi Department of Science Teaching Hebrew University Jerusalem

  12. Factors affecting compliance • Race/culture: Study by White & Verdolini (in Verdolini & Ramig, 2001) • African-American gospel singers; Caucasian classical choral singers; about 50% of gospels singers hoarse; about 30% of classical singers hoarse on day of survey • Azjen & Fishbein mathematical model (Azjen & Fishbein, 1970, 1972, 1973, 1974; Fishbein & Azjen, 1975): B = IF + SN B = behavior (intention to seek treatment) IF = individual feelings about treatment seek SN = social norms about treatment seek

  13. Raw-Score Regression Weights are Shown, Based on 7-Point Ordinal Scale (-3 = Extreme Negative Influence; 0 = Neutral Influence; +3 = Extreme Positive Influence). Probability for Equations p Set at α = 0.10. (Data From White and Verdolini, Published in Verdolini & Ramig, 2001.)

  14. Factors affecting compliance • Pt’s educational level: Little or no effect, or positive effect (CPAP for sleep apnea and heart failure; e.g. Evangelista et al., 2001; Hui et al., 2001). • Income: High-income and unemployed tend to be most compliant (e.g. al-Shammari et al., 1995; Lane et al., 2001; Pan et al., 2001; Pang et al., 2001) discussion?) dailyclipart.net

  15. Factors affecting compliance • Geography: Rural may decrease compliance (e.g. Eaker et al., 2001; Pan et al., 2001) • Transportation: Lack decreases compliance (e.g. Langkamp & Hlavin, 2001) • In most studies, single demographic factors do not explain compliance; combinations of factors may • E.g. F, adolescent, large sibship, not accompanied by parent decreased antibiotic use following rheumatic fever (Gordis et al., 1969). cars-and-trees.com

  16. Factors affecting compliance COGNITIVE, PERSONALITY, ATTITUDE FACTORS • Forgetfulness impacts negatively; remembering helps (e.g. al-Shammari et al., 1995; Chesney et al., 2000; Donohoe et al., 2001) • Some psychiatric conditions may decrease compliance (e.g. (DiMatteo, 1995; Gordillo et al., 1999; Shemesh et al., 2001) • Positive pt attitude about disease (I’m going to deal with this) increases compliance (e.g. Scherer & Bruce, 2001) • Confidence in treatment increases compliance (e.g. Donohoe et al., 2001) lost100pounds.wordpress.com

  17. Factors affecting compliance productivity501.com Locus of control Self-efficacy http://3.bp.blogspot.com/_7YR-Rsp2dxo/TOjKdHWkPoI/AAAAAAAAADM/4-gpgyDinjg/s1600/untitled.jpg

  18. Factors affecting compliance • Locus of control: • Men tend to have external locus for errors, internal locus for merit; women tend to have reverse (reference lost to follow-up!) • In health care, external locus of control negatively predicts compliance with medical treatment (e.g. HIV+; Gordillo et al., 1999)

  19. Factors affecting compliance • Self efficacy (Bandura, 1977) • One’s belief in one’s ability to carry out a behavior • State- not trait-specific (varies across situations; e.g. (Kaplan, Atkins, & Reinsch, 1984) • Experimentally manipulable with affective rewards in clinical environment (e.g. (McAuley et al., 1999) get-real-fitness.com

  20. Factors affecting compliance • Hundreds and even thousands of studies show positive influence of self-efficacy on compliance • E.g., osteoporosis prevention, alcoholism treatment, renal transplantation meds, treatment for atopic dermatitis, HIV retroviral meds, asthma treatment, exercise prescription, drug treatment for rheumatoid arthritis (quick lit review largely from 2001; in Titze & Verdolini, 2011)

  21. Factors affecting compliance • Self-efficacy for voice (Gillespie & Verdolini Abbott, 2011) • Fourteen teachers with self-declared voice problems • Received education about causes and treatments for common voice problems in teachers • Randomly assigned to (1) “abuse/misuse” language educational video; (2) neutral language educational video (double-blind) sptimes.com

  22. Factors affecting compliance • Self-efficacy for voice measured before and after exposures • Results showed subjects in “abuse/misuse” group did not show a reduction in self-efficacy for voice pre- to post-exposure • However, subjects in “neutral” group showed an increase in self-efficacy for voice with the exposure • Conclusion: Normal increases in self-efficacy, expected with patient education, was harmed by “abuse/misuse” language

  23. Factors affecting compliance • Larger-N studies needed for verification • Further studies also needed to determine effects of voice-related self-efficacy shifts on patient compliance and treatment outcome • For now, some evidence is shown that “abuse/misuse” language may harm people’s self-efficacy for voice • We should therefore question seriously whether we should use the terms or not (I say not!)

  24. Factors affecting compliance • “Readiness” (Motivational Interviewing) • SE theory says people don’t comply because they feel they can’t • MI theory says people don’t comply because they feel they’re not ready • MI techniques help patients move through various stages to “readiness” • (For background and review relevant to voice, see Behrman, 2006)

  25. Factors affecting compliance SOCIAL VARIABLES • Social and family support enhance compliance, including HIV, diabetes, hemodyalysis (e.g. Kaplan, Atkins, & Reinsch, 1984) • Review study by White (gospel singers) (see previous discussion)

  26. Factors affecting compliance TREATMENT VARIABLES • Patient education: May or may not increase compliance (however note that often pts don’t understand what you tell them; 50% in one study; pts also forget about half of what you tell them quickly; Boyd et al. 1974; Spelman et al. (1967) • Pt’s perception of increased explanation may be the key for compliance (e.g. lipid-lowering drugs; Kiortis et al., 2000) http://bossip.files.wordpress.com/2010/10/dartmouth-old-lady-black-doctor-e1286646111253.jpeg?w=600&h=400

  27. Factors affecting compliance • Information exchange: Match between pt’s desire for active participation and information may be key (e.g. Krantz et al., 1980)

  28. Factors affecting compliance • Frequency of treatment: Negative effect (e.g. depression, fertility meds; de Klerk, 2001; Kruse et al., 1993). • Complexity of treatment (dose number of time consumption): Negative impact (e.g. al-Shammari et al., 1995; hemophilia, Hacker et al., 2001; lipid-lowering drugs, Kiortsis et al., 2000) • Relation to voice therapy?

  29. Factors affecting compliance • Written instructions: Possibly positive effect (e.g. DiMatteo & DiNicola, 1982) • Asking pts to repeat back instructions: May help (e.g. DiMatteo & DiNicola, 1982) • Follow-up monitoring: Generally helps (e.g. al-Shammari et al., 1995; Atis et al., 2001). But note paradoxical results for smoking cessation (e.g. Dornelas et al., 2000) • Self-monitoring aids may help (e.g. asthma treatment (e.g. Finkelstein et al., 2001)

  30. Factors affecting compliance • Self-management: May help (e.g. asthma; group had self-treatment strategies in case of exacerbation; greater self-efficacy and predicted self-care behavior at one-year FU; van der Palen et al., 2001) • Contracts: May help in some cases (e.g. severe personality disorders; Miller, 1990) blogs.forbes.com

  31. Factors affecting compliance TREATMENT EFFECTS • Side effects: Negative effect on compliance (e.g.Brook et al., 2001; Kiortsis et al., 2000; Lin et al., 1995) • Experiencing improvement: May help initially (“hook” in voice therapy); but then harm compliance (e.g.depression; (Demyttenaere et al.) etc.usf.edu

  32. Factors affecting compliance Clinician-patient interactionCompelling effect • Mom’s who perceived docs as business like had poorer satisfaction than if perceived as warm and caring (e.g. Korsch et al. (1968); Korsch & Negrete (1972) ; dissatisfaction led to poor compliance (e.g. (Francis et al., 1969). • Docs viewed as warm and friendly were considered nice and competent; docs seen as cold and aloof considered unfriendly and incompetent (e.g. Ben-Sira, 1976, 1980)

  33. Factors affecting compliance • Relevance in today’s referral patterns?

  34. Compliance package? zebrarug.com

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