Barriers to Modifying Health Behaviors

1
Barriers to Modifying Health Behaviors

• Gradient of Reinforcement
• Immediate rewards and punishments
• Social and Physical Environment

2
Predictors of Patient Adherence
Findings Studies
I. Disease Characteristics

• Severity of illness
• HIV no relationship
  Catz et al., 2000
  Blindness no relationship Vincent,
  1971
  
• If illness interferes with daily
  activities increases compliance
  DiMatteo DiNicla, 1982 or
  appearance
• Pain with the illness increases
  compliance Becker, 1979
• Side effects of medication (unpleasant HIV
  drugs) decreases compliance Catz et
  al., 2000
• Complex treatment procedures (number of doses
  over three) decreases compliance
  Cramer et al., 1989
• II. Personal Factors

• Increasing Age
• Adults
  
  
  
  exercise up to 4 months increases compliance
  Lynch et al., 1992
  exercise after 4
  months no relationship Lynch et
  al., 1992 cancer
  screening curvilinear relationship
  Thomas et al., 1995 hypertension
  medication increases compliance
  Monane et al., 1996 diabetes medication increas
  es compliance Sherbourne et al.,
  1992 heart disease medication increases
  compliance Sherbourne et
  al., 1992
• Adolescents
• diabetes decreases compliance
  Bond et al., 1992 diabetes decreases
  compliance Olsen Sutton, 1998

3
Predictors of Patient Adherence (cont.)
Findings Studies
II. Personal Factors

• Gender
• exercise program no difference for class
  Oman King, 2000 based
  exercise
• women report higher adherence Oman
  King, 2000 for home exercise
• hypertension medication men and women equal
  Monane et al., 1996
• eating a healthy diet women are more
  compliant Laforge et al., 1994
• mental disorder medication women are more
  compliant Sellwood Tarrier, 1994
• Social Support
• wives support of husbands diet increases
  compliance Bovbjerg et al., 1992
• hemodialysis regimen increases compliance
  Sherwood, 1983
• appointment keeping increases compliance
  Sellwood Tarrier, 1994

• Emotional Support
• diabetes medication increases compliance
  Sherbourne et al., 1992
• heart regimen emotional support better
  Kulik Mahler, 1993
  predictor than marriage
• Personality Factors
• obsessive-compulsive increases compliance
  Kabat-Zinn Champman-
  Waldrop, 1988
• cynical hostility decreases compliance
  Christensen et al., 1997

4
Predictors of Patient Adherence (cont.)
Findings Studies
II. Personal Factors

• Emotional factors
• stressful life events decreases compliance
  Oman King, 2000
• anxiety decreases compliance
  Brain et al., 1999
• avoidance coping decreases compliance
  Sherbourne et al., 1992
• personal control increases compliance
  Helby et al., 1989

III. Cultural Norms

• Diabetic and hypertensive patients in Zimbabwe
• belief in traditional healers decreases
  compliance Zyazema, 1984
• Latino Patients
• physicians knowledge of Hispanic
  culture increases compliance Ruiz
  Ruiz, 1983

• Physicians stereotype of African
  Americans decreases compliance van
  Ryn Burke, 2000
• Physicians stereotype of low-income
  patients decreases compliance van
  Ryn Burke, 2000

IV. Practitioner-Patient Interaction

• Verbal Communication
• Patients confidence in physicians
  competence increases compliance
  Gilbar, 1989
• Physicians disinterest decreases compliance
  Russell Roter, 1993
• Physicians personal qualities
• friendliness increases compliance
  DiNicola DiMatteo, 1994
• Being a women female doctors provide
  Hall et al., 1994 more information

5
Diabetes

• Metabolic disease characterized by abnormalities
  in the bodys ability to secrete or to
  effectively use insulin
• Failure to metabolize sugar causes an excess of
  glucose in the blood

6
Type I Diabetes

• Insulin-dependent diabetes
• Develops in children between the ages of 5-13
• Managed primarily with daily injections of
  insulin
• Abrupt onset of symptoms
• May result from viral infection, autoimmune
  reaction, and genetic factors
• Accounts for 10 of all diabetes
• symptoms include
• Frequent urination
• Unusual thirst
• Irritability
• Nausea
• fainting

7
Type II Diabetes

• Develops usually after age of 40, but can develop
  at a younger age
• Not as serious as Type I
• Individual produces some, though not enough
  insulin
• Strong association with obesity

8
Characteristics of Type I and Type II Diabetes
Mellitus
Type I Type II Onset occurs before age
30 Onset may occur during childhood or
adulthood Patients are underweight Patients are
overweight Patients experience frequent thirst
and urination Patients may or may not experience
thirst/urination Affects equal numbers of men and
women Affects more women Has no socioeconomic
correlates Affects more poor than middle-class
people Requires insulin injections Requires no
insulin injections Carries risk of kidney
damage Carries risk of cardiovascular
damage Accounts for 10 of diabetics Accounts
for 90 of diabetics
9
Adherence and Diabetes

• Rosenstock (1990s)
• 80 percent of diabetics incorrectly administer
  their insulin
• 73 percent did not follow their diet
• 50 percent carried out poor foot care
• 45 percent incorrectly tested their urine
• Only 7 percent complied with all the steps for
  good control

10
Adherence and Diabetes

• Reasons for poor adherence
• Psychological stress
• Pressure to eat
• Adherence to altering lifestyle behaviors
• Medical information seen as advisory
• Complexity of regimen
• Are often asymptomatic

11
Improving Adherence

• Patients and physicians must agree on treatment
  goals
• Social support?
• Interventions that focus on improving
  self-control
• Role of family

12
Changing Health-Relevant Beliefs Behaviors

• Educational Approaches
• Predisposing factors
• Motivate decisions to take particular health
  actions
• Awareness, understanding, attitudes, and health
  beliefs
• Enabling Factors
• Types of skills needed to carry out an action
• Ability to carry out a self-examination
• Reinforcing factors
• Rewards that one obtains for the performance of
  the health behavior in question
• Peer approval and stress reduction