9990 · 3.2.1
Types of non-adherence and reasons why patients do not adhere flashcards
Revision flashcards for Cambridge 9990 Types of non-adherence and reasons why patients do not adhere (syllabus 3.2.1). Flip, recall, then mark a real past-paper question.
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Adherence vs compliance?
Adherence — active agreement with treatment plan; compliance implies passive obedience. Modern usage prefers **adherence** (patient partnership).
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Unintentional non-adherence?
Patient intends to follow treatment but fails — e.g. **forgetfulness**, misunderstanding instructions, complex regimen.
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Intentional non-adherence?
Patient deliberately deviates — e.g. stops medication when feeling better, fears **side effects**, or rejects diagnosis.
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Health Belief Model — four key components?
Perceived **susceptibility**, **severity**, **benefits** of action, and **barriers** to action — plus **cues to action** and **self-efficacy**.
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Why stop antibiotics early?
Symptoms improve → low perceived severity; underestimating risk of **antibiotic resistance** — intentional non-adherence.
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Demographic factor in non-adherence?
Older adults may face **polypharmacy** and confusion; younger adults may feel invulnerable — but age alone is a weak predictor; **beliefs** matter more.
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Define 'adherence' in a healthcare context.
The extent to which a person's behaviour—taking medication, following a diet, or executing lifestyle changes—corresponds with agreed recommendations from a healthcare provider.
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What is intentional non-adherence?
A conscious and active decision by the patient to not follow a prescribed treatment plan. This is often based on their personal beliefs, a cost-benefit analysis of the treatment, or experiences with side effects.
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What is unintentional non-adherence?
A passive failure to follow a prescribed treatment plan, where the patient intends to adhere but is prevented by barriers. Common causes include forgetfulness, misunderstanding instructions, or practical difficulties.
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Give two patient-centred reasons for intentional non-adherence.
1. Negative beliefs about the medication (e.g., it is harmful or ineffective). 2. Experiencing unpleasant side effects that outweigh the perceived benefits of the treatment.
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Give two practical barriers that can lead to unintentional non-adherence.
1. Complexity of the treatment regimen (e.g., multiple pills at different times). 2. Financial cost of the medication or difficulty physically accessing a pharmacy.
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What is 'polypharmacy' and how does it relate to non-adherence?
Polypharmacy is the simultaneous use of multiple medications by a patient. It increases the risk of unintentional non-adherence due to regimen complexity, potential for confusion, and a higher chance of drug interactions and side effects.
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How is the Medication Possession Ratio (MPR) used to measure adherence?
MPR is a quantitative measure calculated as (days' supply of medication obtained / number of days in period) x 100. A higher MPR suggests better adherence, with >80% often used as a benchmark for 'adherent'.
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Explain the 'intention-behaviour gap' in relation to health adherence.
This is the gap between what a person intends to do (e.g., 'I will take all my pills') and what they actually do. Models like HBM can explain intention, but factors like self-efficacy, habit, and practical barriers determine if intention translates into behaviour.
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What is 'rational non-adherence'?
A term for intentional non-adherence where the patient's decision to not follow treatment is based on a logical, reasoned process from their perspective, such as weighing the severe side effects against limited perceived benefits of the medication.