Adherence to medical advice: improving adherence

Psychology A2 · Health Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Children adhere better when treatment is easy and rewarding. Chaney et al. (2004) compared a normal asthma spacer with the Funhaler, which has a spinner and a whistle that work when the child breathes correctly. Parents reported better adherence with the Funhaler.

For individuals, three behavioural techniques are used. A contract is a written agreement with goals and rewards. A prompt is a reminder, such as a text message. Customising fits the treatment to the patient’s routine.

Community interventions target whole groups. In the key study, Yokley and Glenwick (1984) randomly allocated families of preschool children who were behind on immunisations to different interventions or to control groups. A money incentive worked best, then extra clinic hours, then a specific prompt.

Rules to remember

Funhaler: uses positive reinforcement (operant conditioning) to make inhaler use fun.
Contract: agreed targets, signed by patient and practitioner, with rewards.
Prompt: a cue at the right time (text, phone call, alarm, calendar pack).
Customising: simpler doses and timing matched to the patient’s daily life.
Yokley and Glenwick: IV was the type of intervention; DV was the number of children immunised, taken from clinic records.
Their groups: general prompt, specific prompt, specific prompt + increased access, specific prompt + money incentive, and two control groups.
Result: the general prompt had little effect; the specific prompt with a money incentive had the most.

Common mistake

Students say any reminder works. In Yokley and Glenwick the general reminder did not; the prompt had to name the child and the vaccines needed.

Worked example

A health centre posts every family the same leaflet saying “Immunisation protects children.” Uptake hardly changes. What does Yokley and Glenwick’s study suggest it should do?

The leaflet is a general prompt: it does not name the child or the vaccines due.
In the study, a general prompt had little effect on immunisation.
Specific prompts worked better, and more so with easier access or an incentive.

Answer: Send a specific prompt naming the child and the vaccines due, and add extra clinic hours or an incentive.

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