9990 · 3.2.3
Improving adherence flashcards
Revision flashcards for Cambridge 9990 Improving adherence (syllabus 3.2.3). Flip, recall, then mark a real past-paper question.
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Patient education intervention?
Clear verbal and **written instructions** about medication purpose, dosage, and side effects — targets **knowledge gaps** causing unintentional non-adherence.
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Regimen simplification?
Reduce dosing frequency (e.g. once-daily vs three-times-daily) — lowers **practical barriers** in Health Belief Model.
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Motivational interviewing (MI)?
Client-centred counselling exploring **ambivalence** about treatment — elicits patient's own reasons for change rather than lecturing.
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SMS reminder systems?
Automated text messages prompt medication taking — effective for **unintentional** non-adherence; low cost, scalable.
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Social support role?
Family reminders and encouragement improve adherence — especially in elderly or paediatric patients.
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Multi-component intervention?
Combining education + reminders + simplified regimen + belief-change — more effective than single strategies alone.
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What is the primary goal of a behavioural intervention for adherence?
To modify the patient's actions directly using principles of learning theory, such as reinforcement, prompts, and cues, to make adherence a habit.
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Define 'concordance' in the context of patient adherence.
A collaborative agreement between a patient and their healthcare practitioner regarding the treatment regimen. It respects the patient's beliefs and wishes, moving beyond simple compliance to form a therapeutic partnership.
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Give an example of a cognitive intervention to improve adherence.
Providing detailed, easy-to-understand written information about the illness and the rationale for the treatment, or using CBT to challenge a patient's fearful or irrational beliefs about medication side effects.
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What did Ley (1988) suggest were the main cognitive reasons for non-adherence?
A failure to understand the information provided by the practitioner and/or a failure to remember it accurately. This is often summarised as 'satisfaction, understanding, and recall'.
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How can 'tailoring the regimen' improve adherence?
It is a behavioural strategy where the treatment plan is simplified and fitted into the patient's existing daily routine (e.g., linking medication to mealtimes), reducing practical barriers and making adherence easier to maintain.
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What is a dosette box (pill organiser)?
A behavioural aid with compartments for different days and times, helping patients manage complex medication schedules. It acts as a visual cue and simplifies the regimen, reducing unintentional non-adherence due to forgetfulness or confusion.
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Explain 'contingency contracting' as an adherence strategy.
A formal behavioural agreement where the patient receives specific rewards (reinforcers) for achieving adherence goals (e.g., taking 90% of doses). It is based on operant conditioning principles.
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What is a major limitation of purely educational interventions for adherence?
They may increase knowledge but fail to change behaviour if practical barriers (e.g., cost, complex schedule) or strong, irrational beliefs are the primary cause of non-adherence. They are often insufficient on their own.