Psychology 407 - Health Psychology
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Week 2 Notes: Compliance and Adherence to Medical/Health Regimens

I. Medical vs. Health Model of Compliance

 

II. Passive (Patient) One-Way Arrogant communication

(Ginny: "you vill not scream")

III. Compliance vs. Adherence vs. Correspondance

 

IV. Can We predict Compliance/Adherence on basis of?:

*Personality (cf psychosomatic types) (Mom Diab)

*Ethnicity, Intelligence or Income

*Past Behavior

*Complexity of Regimen

*Sx reducing or Sx creating (HBP)

V. How Bad is Compliance Problem?

50% HBP

MD Instruction Study (50% didn’t know what to do with Rx)

 

VI. How to Track Compliance

A. Self monitoring

VA Stress and Pain Groups

SUDS Scale.

B. biochem assay

*smoking

*tracer/marker

*relax compl. study paper

*riboflaven HBP study

* ‘bogus pipeline’

V. How to Modify compliance

Sr+/Contracting

Deposit Contracts

Public Disclosure

Feedback and Praise

VA Mktg studies

Smoking Tx graphs

Intensive SM/Tx?

Response Cost/effort

Low Ball

VI. Motivational Interviewing and Compliance

Role of Clarification, Formulation & Feedback

 

VII. Direct Effect of Compliance

Cholestyramine Study

FaithBelief Factor.

 

 

VIII. Compliance/Adherence Research

 

Efficacy: The ability of a treatment to produce benefit in those who take the treatment.

Effectiveness: The ability of a treatment to produce benefit in those to whom the treatment is offered.

Methods of Health Behavior Change...

Principles of Behavioral Analysis and Intervention

A. Models of Change

1. Public Health (Community)

2. Clinical

(a) Psychodynamic (Freud)

(b) Existential/Experiential

(c) Religious/Spiritual

(d) Humanisitic

(e) Learning Theory

(1) Classical Conditioning

*Sweet Roll & Insulin

*Immune Response/CA/trauma

(2) Operant/Instrumental

Health Beh. Paradox

(healthy beh=neg ST conseq

unhealthy beh=pos ST conseq)

(3) Social/Cognitive

Smoking/teens

Gang violence/modeling

Type A, models and social Reinf.

Behavioral/Learning Approaches to

Health Risk Modification

Instructional Control Heiarchy:

1. Instructions (OCD woman ex)

2. Agreement ("I’ll try"/ "I will")
verbal

written

3. Contracting (Dep. contracts)

 

Interventions

Stimulus/Antecedent Control

Study S+; Stairs (Brownell)

Schacter clock/eat studies

Reinforcement Control

Punishment/Response Cost (Doc. Contract)

Social Skills Training Paradigm

Instruct

Model

Reherse/Practice

Evaluate/Feedback

Acquisition vs. Maintenance

Different Strokes?

Behavioral Economics

Free Market/Free Choice

Consumer Behavior Prediction

Maximization of Reinforcement

No Free Choice (Closed System): Prison, Military,NARC

 

Health Behavior Change: Readiness to Change

Stages of Change (Transtheoretical Model)

*Model, not necessarily reality

*Effort to explain how people change

*Circular. May require multiple cycles

  1. Pre-Contemplation (no/6 mos)

2. Contemplation (want to in 6 mos)

3. Preparation/Determination (irregular)

4. Action (<6 mos practice)

5. Maintenance (compliance >6mos)

 

 Motivational Interviewing:

Help in becoming unstuck/ambivalence

Freedom of choice/avoiding resistance to change

Facilitating Conditions for Change/action.

Stage	Counseling Phase	Goals
Precontempl	Clarification	consciousness raising incr awareness of need for change
Contemplation	Clarification II	Incr. motiv and commitment for change
Determination	Formulation	Formulate problem, find approp. intv/referal
Action	Intervention	Take steps toward desired change
Maintenance/ Relapse	Intv./Termin. Renew Clarif Formul and/or Intervention	Prevent relapse Renew Motiv, Commit and/or action

Relapse Prevention:

AVE

Slip/Lapse, Relapse, Collapse (Alc/smk)

AIDS

Guilt & Shame vs. Responsibility

 

Active Ingredients of Effective Brief Counseling

(FRAMES)

1. Feedback

2. Responsiblity

3. Advice

4. Menu

5. Empathy

6. Self-Efficacy

 

8 General Motivational Strategies: (A-H)

1. Giving Advice

2. Removing Barriers

3. Providing Choice

4. Decreasing Desirability

5. Practicing Empathy

6. Providing Feedback

7. Clarifying Goals

8. Active Helping

 

Five Clinical Principles of MI

1. Express Empathy

2. Develop Discrepancy

3. Avoid Argumentation

4. Roll with Resistance

5. Support Self-Efficacy

 

***Strengthening Motivation and Commitment for Change***

I. Precontemplation:

1. State your concern (consequences of beh./situa.)

2. Avoid Argument

3. Elicit Person’s Own Concern

4. Elicit Person’s Concern for Others

5. Reflect (listening acceptance)

II. Contemplation:

1. Personal FEEDBACK (evaluation)

2. Emphasize Personal RESPONSIBILITY/ Change

3. Offer ADVICE

4. Provide a MENU OF OPTIONS.

5. EMPATHIC counseling Style

6. Encouragement and Optimism for SUCCESS

7. Increase DISCREPANCY/DISSONANCE for

not changing.

III. Determination

A. Help STRENGTHEN MOTIVATION

B. Look for SIGNS OF READINESS for change.

1. decr. Resistance (stops arguing)

2. decr. Questions re: problem

3. Incr. Resolve. (reached solution)

4. Self-Motivation Statements appear

(I need to do something; this is serious)

5. Incr. Questions about Change.

6. Envisioning (how life might be)

7. Experimenting (trying out new beh.)

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