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9990 · 3.2.1

Types of non-adherence and reasons why patients do not adhere — practice questions

Practice and worked examples for 9990 Types of non-adherence and reasons why patients do not adhere. Short previews only — attempt the full question in MarkScheme against the official scheme.

Worked example 1

James, 58, has hypertension. His GP prescribed daily medication, but James often forgets doses and stopped taking the pills when his headaches disappeared.

(a) Classify James's non-adherence using appropriate terminology. [3 marks] (b) Apply the Health Belief Model to explain James's behaviour. [4 marks] (c) Evaluate the Health Belief Model as an explanation of non-adherence. [5 marks]

Show solution outline

(a) Classification:

  • Unintentional non-adherence — forgetting daily doses.
  • Intentional non-adherence — deliberately stopping medication when symptoms resolved.

(b) Health Belief Model applied:

  • Low perceived severity: Headaches gone → James believes hypertension is no longer serious.
  • Low perceived susceptibility: No symptoms = no perceived risk of stroke or heart attack.
  • Perceived benefits low: Does not see benefit of continuing medication when feeling well.
  • Barriers: Daily regimen is inconvenient; possible side effects.
  • Low cues to action: No visible symptoms to prompt continued medication.

(c) Evaluation of HBM:

  • Strengths: Identifies modifiable beliefs — interventions can target perceived severity (education) and benefits (explain silent nature of hypertension).
  • Supported by research: Becker (1978) found HBM predicted diabetic adherence — perceived seriousness and benefits were key.
  • Limitations:
    • Ignores habit and routine — forgetting is not always belief-driven.
    • Cultural bias — developed in US; may not account for collectivist health decision-making (family decides).
    • Rational model — assumes people weigh costs/benefits logically; Kahneman shows decisions often use heuristics and emotion.
    • Does not fully explain intention–behaviour gap — knowing benefits does not guarantee action (need self-efficacy, Bandura).

Judgement: HBM is a useful starting framework but best combined with practical reminders (3.2.3) and self-efficacy interventions.

Worked example 2

A patient, Maria, is prescribed a new medication for a chronic condition. The regimen requires her to take one tablet, twice a day. The prescription is for a 30-day supply (60 tablets). At the end of the 30 days, a pill count reveals she has 18 tablets remaining.

(a) Calculate Maria's adherence rate for the 30-day period as a percentage. [3 marks] (b) Using a common clinical threshold of 80% for adequate adherence, determine if Maria would be considered adherent. [1 mark] (c) Maria tells her doctor she sometimes feels the medication makes her nauseous, so she skips her morning dose on days she has an important meeting. She also admits to simply forgetting her evening dose on a couple of occasions. Identify and explain the two types of non-adherence demonstrated by Maria. [4 marks]

Show solution outline

(a) Calculation of Adherence Rate:

  1. Calculate prescribed doses: 1 tablet × 2 times/day × 30 days = 60 tablets.
  2. Calculate doses taken: Total supplied (60) - tablets remaining (18) = 42 tablets taken.
  3. Calculate adherence rate: Adherence Rate (%) = (Number of doses taken / Number of doses prescribed) × 100 Adherence Rate (%) = (42 / 60) × 100 Adherence Rate (%) = 0.7 × 100 = 70%.

(b) Classification of Adherence: Maria's adherence rate is 70%. Since this is below the 80% threshold, she would be classified as non-adherent.

(c) Types of Non-Adherence:

  1. Intentional Non-Adherence: Maria actively decides to skip her morning dose to avoid the side effect of nausea before important meetings. This is a conscious, deliberate choice based on a personal cost-benefit analysis (the benefit of avoiding nausea outweighs the perceived benefit of taking that specific dose).
  2. Unintentional Non-Adherence: Maria also reports simply forgetting her evening dose on some occasions. This is a passive failure to adhere, where she likely intended to take the medication but was prevented by a lapse in memory or lack of a reminder system.
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