Practise reasons for non-adherence, objective and self-report measurement and improvement through prompts, contracts, models and child-focused interventions.
Dr Munsi is concerned that some of her elderly patients with heart disease do not take their medication every day. Dr Munsi uses the Health Belief Model to design a leaflet to reduce non
adherence in her elderly patients.
Suggest what Dr Munsi could include in her leaflet to reduce non-adherence in the elderly patients, using the Health Belief Model.
-adherence in her elderly patients.
Suggest what Dr Munsi could include in her leaflet to reduce non-adherence in the elderly patients, using the Health Belief Model.
Award 3-4 marks for a detailed answer with clear understanding of Health Belief Model linked to helping Dr Munsi reduce non-adherence.
Award 1-2 marks for a basic answer with some understanding of Health Belief Model linked to helping Dr Munsi reduce non-adherence.
Likely suggestions for leaflet:
- Outline heart disease including short and long term symptoms and outcomes (increases knowledge of the disease).
- Opening hours of clinic and pharmacy with transport links so that it is easy for the elderly patient to attend the clinic/collect their medication (reduces barriers to access).
- Typical medications for heart disease and what the medication does to improve the heart (improves perception of benefits of the medication).
- Explain the possible side effects and likelihood of experiencing these side effects (knowledge of perceived cost/negative of medication).
- Space for Dr Munsi to write the individual patient's medication and how to take it (personalised information - could increase patient satisfaction with Dr Munsi/the clinic).
- Provide leaflet in large font size so easy for elderly patients to read (specific to the demographic)
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Needs to refer to improve adherence/reduce non-adherence to taking medication every day.
If no context max 2 marks.
Context = elderly patients and/or heart disease and/or taking medication every day.
1 or more suggestions for the leaflet is allowed.
Do not allow ideas that are linked to leading to high fear arousal. Ideas linked to low fear arousal are okay only when clearly linked to HBM.
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Example:
Dr Munsi should design her leaflet about heart disease to include information on the short term and long term symptoms of the disease. (1) The health belief model suggests that knowledge about the disease increases the likelihood that patients will adhere to taking their medication as they understand the consequences of heart disease without medication. (1) She could also include the side effects of the medication and the likelihood of experiencing each side effect. (1) This would give her patients the correct knowledge of the negatives of the medication. (1) As the positive reduction in symptoms and protecting the heart in the long term is known due to the leaflet, the positives outweigh the costs and patients should decide to take the medication. (1)
Other appropriate responses should also be credited.
Explain what is meant by an 'objective measure of adherence', in relation to medical advice. Include a biological measure as an example.
Syllabus 3.2.2
- objective measures focusing on pill counting and medication dispensers, including a study, e.g. Chung and Naya (2000).
- biological measures including blood and urine samples.
Award 1 mark explanation.
Award 1 mark for example.
Answers may include:
- objective is fact, a measure that cannot be disputed (1)
- for example, if a drug is detected in blood or urine then it is an objective fact (+1)
Other appropriate responses to be credited.
Suggest how adherence can be measured objectively, other than using a biological measure.
Suggest how adherence can be measured objectively, other than using a biological measure.
Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied.
Answers may include:
- pill counting (Chung and Naya, 2000) (1) (e.g. Chung and Naya, 2000) used trackcap to record the number of pills (assumed to have been taken) (2)
- repeat prescriptions (1) (e.g. Sherman et al., 2000) obtaining repeat prescriptions and analysing without patients' knowledge. Assumption is that if prescription repeated the original must have been used (2).
Other appropriate responses to be credited.
Explain two weaknesses of using biological measures of adherence to medical advice.
Explain two weaknesses of using biological measures of adherence to medical advice.
Up to 2 marks for each weakness ×2.
Award 2 marks for an appropriate weakness stated and applied as required by the question with detail / elaboration / example.
Award 1 mark for an appropriate weakness stated but not applied.
Answers may include:
- Data needs to be collected and this may be invasive for the participant (1) such as collecting blood (2).
- Data collection may be embarrassing for the participant (1) such as giving a urine sample or spitting into a salivette (2).
- A participant may not give informed consent to the data collection method (1) so biological data is not collected about adherence (2).
Other appropriate responses to be credited.
From the key study by Yokley and Glenwick (1984) on improving medical adherence using community interventions:
Describe one cause of confounding identified by Yokley and Glenwick.
Describe one cause of confounding identified by Yokley and Glenwick.
Syllabus: 3.2.3: Key study on improving medical adherence using community interventions: Yokley and Glenwick (1984).
Marks: Award 2 marks for a detailed description. Award 1 mark for a partial description.
Definitive answer:
- confounding may have resulted if individual children were targeted and children in the same family received different mail prompts emphasising different things.
Explain what was done in the study by Yokley and Glenwick to prevent confounding.
Explain what was done in the study by Yokley and Glenwick to prevent confounding.
Marks: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation.
Definitive answer:
- rather than individual children, individual families were targeted (1 mark) which meant that only one prompt was sent to each family (2 marks)
- randomly assigned to one of six conditions.
Suggest one strategy for promoting health that could be used to improve medical adherence, other than the strategy used by Yokley and Glenwick.
Marks: Award 2 marks for an appropriate suggestion and applied to study
with detail / elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied.
Answers may include (other appropriate responses to be credited).
- providing information on the benefits of medical adherence (1 mark) such
as that used by Lewin (heart health manual) to tell people why they need
to adhere (2 marks)
- using fear arousal on the problems associated with medical non-adherence (1 mark) such as the strategy used by Janis and Feshback to
scare people into adhering (2 marks)