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Allied Health: Articles of Interest Motivating Patients to Change Asthma Medication Adherence Behavior Because patient adherence to asthma controller medications is less than 50 percent, according to most studies, medication adherence behavior is one of the most frequently studied behavioral change topics in asthma research. In this article, we shall discuss:
Asthma research findings indicate very clearly that patients do not have accurate knowledge regarding their disease. The Asthma in America study demonstrated that only 10 percent of patients said asthma was caused by inflammation. Futhermore, 63 percent of patients said they were taking medications to reduce inflammation when in fact the medicines were not for inflammation. A lack of accurate knowledge may be directly related to a lack of medication adherence. According to cognitive psychology, our knowledge is organized into mental schemas which frequently guide our everyday behaviors. Most of the information represented in the schema is inaccurate when we compare it to National Heart, Lung and Blood Institute (NHLBI) guidelines. But for patients, their erroneous schema will guide their everyday behavior, including the failure to adhere to their controller medication plan. A patient’s motivation to change is another key variable that impacts adherence behavior. Prochaska’s transtheoretical model states that for any particular behavior change, individuals are at one of five stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance. For example, consider the case of a man who is using his rescue medication more than five times a week and only using his controller medication occasionally. According to the NHLBI guidelines and the “Rules of Two,” his asthma is not well-controlled and he is overusing his rescue inhaler, and under-using his controller medication. If he is in the precontemplation stage he does not perceive a problem with his present behavior and is not considering a change. If he is in the contemplation stage he might be having some negative outcomes (such as acute asthma episodes) but still decides against changing. If he is in the preparation stage of change then he might decide to make a change such as seeking advice from his HCP. If he is in the action stage, he may have already made some medication changes and might inform you about them. Finally, if he is in the maintenance stage he has already made the medication change and can benefit from measures that reinforce his adherence to the controller medication plan. How can HCPs help patients change their asthma medication adherence behavior? Research indicates that effective medical interviewing is an excellent method for helping patients to change behavior. If the medical interviewing is done properly, the patient will self-disclose information regarding his schemas and his readiness to change. According to Marvel, effective medical interviewing involves asking open ended questions about the patient’s knowledge, emotions, beliefs, goals and expectations. In the ensuing conversation, the HCP should utilize humanistic communication skills that provide empathy, validation and psychosocial support. Effective use of non-verbal communication skills, such as eye contact, attentiveness and voice quality, will enhance the relationship and trust between the HCP and the patient, which in turn will lead to more self-disclosure regarding possible behavioral changes. These types of skills are patient centered and may take a little extra time in the short term, but in the long run they can improve management and adherence outcomes. In asthma, medical interviewing research by Noreen Clark has indicated that effective communication strategies by HCPs fall into three categories:
Using a treatment plan focus, the HCP tailors the recommended medication plan to the family’s routine, reaching agreement on short and long term goals and helping patients to use criteria for making decisions about asthma management. Congenial demeanor includes showing non-verbal attentiveness, maintaining interactive conversation and providing verbal praise. Reassuring communication involves finding out the patients’ underlying concerns and fears regarding treatments and providing reassuring information. Clark also recommends that HCPs should explore different communication patterns with patients and use patient reactions to evaluate the effectiveness of their communication behavior. Patients change their medication behaviors based on their readiness to change and their mental schema knowledge. According to research, HCPs need to ask open-ended questions to assess these cognitive variables. Such a task is best accomplished using motivational interviewing techniques. HCPs can then work on developing a partnership with their patients, who ultimately will make the final decision regarding medication adherence and other behavioral changes. References 2. NHLBI National Asthma Education and Prevention Program. Expert panel report 2: Clinical practice guidelines: Guidelines for the diagnosis and management of asthma. National Institute of Health; National Heart Lung and Blood Institute. NIH Publication No. 98-4051: July 1977. 3. Asthma in America, GlaxoWellcome Inc. Research Triangle Park NC 27709 1998 4. Prochaska JO, DiClemente CC, Norcross JC: In search of how people change: applications to addictive behaviors. Am Psychol 1992;47:1102-1114. 5. Marvel MK, Doherty WJ, Weiner EW: Medical interviewing by exemplary family Physicians. J Fam. Pract. 1998;47:343-348. 6. Clark NM, Gong M, Schork MA, Maiman LA, Evans D, Hurwitz ME, Roloff D, and Mellins RB: A scale for assessing health care providers’ teaching and communication behavior regarding asthma. Health Educ. & Behav. 1997;24:245-56. |
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