Why do people listen to doctors then if drugs do
Adherence is important issue – evidence shows
generally adherence rates are low.
Simons et al (96) shows that even for Statins
(drugs to reduce cholesterol which have few side
effects) adherence rate is only 70%.
Looking at the cognitive decision making process
that people go through in order to decide to take
Linked to HBM – cost & benefit analysis. If costs
outweigh benefits the logical decision is not to
Studies have suggested
that about half the patients
with chronic illnesses such
as diabetes and
hypertension (high blood
pressure) are non-compliant
with their regime. There is
clearly a large financial cost
for this in wasted drugs but
also potentially in poor
50% of patients in America did
not take prescribed
medications according to the
instructions and scheduled
appointments for treatment
were missed 20-50% of the
Where compliance means
going against well established
habits and going against
strong motives (e.g. giving up
smoking) compliance is even
Taylor (1990) suggested that 93% of patients fail to adhere to some aspect ofTaylor (1990) suggested that 93% of patients fail to adhere to some aspect of
their treatment.their treatment.
Sarafino(1994) argued that people adhere reasonably closely about 78% of theSarafino(1994) argued that people adhere reasonably closely about 78% of the
time for short-term treatments but only 54% for chronic illness.time for short-term treatments but only 54% for chronic illness.
A study by Becker (1972) looked at whether a prescribed anti-biotic was beingA study by Becker (1972) looked at whether a prescribed anti-biotic was being
taken halfway through a 10 day treatment programme in young children. Overtaken halfway through a 10 day treatment programme in young children. Over
half the mothers had stopped giving the medicine.half the mothers had stopped giving the medicine.
He studied 50 patients for
7 months. After detection
of high blood pressure
only 50%-70% sought
He found that only 65% of
pills were taken.
Only 20% of the patients
took as many as 90% of
33% of those who sought
treatment dropped out.
The question is why?
Rational Choice Theory: people may notRational Choice Theory: people may not
adhere for good reason:adhere for good reason:
1. They have reason to believe the treatment is
2. The side effects are unpleasant or effect the
quality of their lives
YouTube - Ambien Side Effects -- Research Finding
3. There are practical barriers to the treatment
such as cost or social difficulties
4. They may want to check the illness is still there
when they stop.
The patient may not believe
what the doctor has
suggested is in their best
interest. Bulpit (1988)Bulpit (1988)
looked at treatments for
hypertension and found that
the side effects could
include impotence and
problems with ejaculation.
Clearly for some men this
would be seen as
To review research on adherence in hypertensive
Hypertension has no real short-term effects
but in the long term can lead to heart disease and
Review article of range of research which identified
problems with taking drugs for high blood pressure.
Research analysed to identify the physical and
psychological effects of drug treatment on person’s
Anti hypertensive drugs have many side effects
including sleepiness, dizziness, lack of sexual
functioning. They also affect cognitive functioning
and so work and hobbies may be curtailed
Bulpitt reported that one study by Curb found that
8% of men stopped taking their medication due to
He also reported that research by the Medical
Research Council found that 15% of patients had
stopped taking the drug due to other side effects.
The costs of taking some medication appear to outweigh
the benefits for many patients, especially with problems
such as high blood pressure which have no symptoms.
Therefore some types of treatment (asymptomatic ones)
may be more difficult to treat as people cannot feel the
benefits of the adherence.
The more a person feels in control the more likely
they are to comply with their treatment
If we have an internal locus of control we are likely
to have a higher self efficacy – more belief in what
we do makes a difference.
PsychoanalyticPsychoanalytic explanations include avoidance
and denial of the problem
Think back to Freud and his defence
mechanisms how can you relate this to non
adherence to medical advice?
A review article gives data that covers many
countries and gives a overall view of the effects
of taking medicine for hypertension.
No two studies use the same method so is not
Survey data can be inaccurate.
Demand characteristics to look like a ‘ good
Psychology as a science: single blind testing and
randomisation helps to show the real effects of
Usefulness: allows practitioners and patients
aware of the side effects of the medication for
males with hypertension.