Psychology: Supporting Adherence to Care Plans

Psychology: Supporting Adherence to Care Plans

Topic 05

• Utilize psychological principles in enhancing
• adherence of patients to care plansTOPIC CONTENT
• a) Define adherence
• b) Explain what is illness
• c) Explain extent of adherence
• d) Explain factors associated with non-adherence
• e) Explain interpersonal factors
• f) Elaborate social and organizational settings
• g) Explain alternative to adherence
• h) Explain role of optometrist
• i) Explain lived experience of chronic illness
• j) Explain fear of medication and identity control
• k) Explain resistance to medicine/treatment taking
• l) Explain patient empowermentDefine adherence
• Adherence refers to the extent to which a person’s behavior
• such as taking medication, following a diet, or making
• lifestyle changes corresponds with agreed upon
• recommendations from a healthcare provider. It emphasizes
• an active, collaborative, and, voluntary partnership between

patient and clinician, rather than passive obedience.Explain What is Illness Illness is the subjective experience of being unwell. It is how a person perceives, interprets, and acts upon their symptoms.

COUSES OF ILLNESS

Nutritional and Metabolic Imbalances: Malnutrition (deficiency) or overnutrition (excess) can cause disease. Other causes include hormone imbalances or metabolic issues like nutrient deficiencies.

Social and Economic Factors: Economic instability can prevent individuals from accessing proper nutrition and healthcare, leading to illness.

Psychological Factors: Mental health directly impacts physical health, Physical Trauma and Injury: Accidents resulting in broken bones or wounds are a primary cause of acute physical illnessCont….

• Infectious Agents (Pathogens): including viruses (e.g., COVID-19, cold), bacteria (e.g., strep
• throat, tuberculosis), fungi (e.g., skin infections), and parasites (e.g., malaria).
• Lifestyle and Behavioral Choices: Negative habits such as smoking, excessive alcohol
• consumption, lead heart disease, diabetes, and cancer.
• Environmental Factors: Polluted air, contaminated water, lead to cholera or diarrhea.
• Genetic and Physiological Factors: Some illnesses are hereditary, caused by genetic mutations, or

result from the dysfunction of body organs (e.g., pancreas failure leading to diabetes).Explain extent of adherence

• Extent of adherence" refers to the degree to
• which an individual’s behavior such as taking
• medication, following a diet, or executing lifestyle
• changes corresponds with the agreed upon
• recommendations from a healthcare provider.Levels and Measurement of Adherence
• High Adherence: refers to the consistent, long-term following of recommended
• medical treatments, dietary guidelines, or lifestyle changes, often defined in
• research as taking of medication doses correctly. It is strongly associated
• with improved health outcomes, reduced hospitalization, and better
• management of chronic
• Partial Adherence: Common in long-term therapy, where patients skip
• doses or take incorrect amounts.
• Non-Adherence: Complete failure to follow the agreed-upon treatment
• plan.factors associated with non-adherence
• Patient Factors: Forgetfulness, lack of knowledge, low
• motivation, or the belief that the treatment is unnecessary.
• Therapy Factors: Complex, long-term, or expensive regimens,
• and unpleasant side effects.
• Condition Factors: Severity of symptoms (high symptom load

may increase adherence; lack of symptoms may decrease it).factors associated with non-adherence

• Healthcare Team Factors: Poor provider-patient communication,
• lack of follow-up, or low trust.
• Social/Economic Factors: Poverty, low literacy, and lack of social
• support.
• Contextual Factors: Using alternative remedies (herbal/traditional)
• instead of prescribed medicine. Cultural or religious beliefs
• opposing modern medicine.Explain interpersonal factors
• Interpersonal factors are the social, emotional, and
• communicative dynamics that shape how individuals interact,
• influencing behaviors, relationships, and health outcomes.
• These elements including trust, communication styles, social
• support, and power dynamics define the quality of connections

between people in families, workplaces, and friendships.Interpersonal Factors

• Communication Skills: Involves active listening, nonverbal cues (tone, facial expressions), and
• clear messaging.
• Emotional Intelligence & Empathy: Understanding and managing one's own emotions and

recognizing others' emotions.

• Trust & Respect: The foundation for building and maintaining positive, collaborative relationships.
• Conflict Resolution: The ability to navigate disagreements constructively.
• Social Support & Networks: Influence from family, friends, and coworkers, which shapes

attitudes and health behaviors.

• Cultural & Personal Factors: Background, gender, and shared values that influence interaction

dynamics.

• Proximity & Attraction: Physical closeness and perceived similarity, which often initiate
• relationship formation.social and organizational settings
• Social and organizational settings: are structured, dynamic
• systems including workplaces, communities, and institutions
• defined by human interaction, shared norms, and hierarchical
• roles. These environments act as open systems, where
• relationships and culture (values, beliefs) evolve to adapt to
• internal and external influences.Social settings:
• Social Settings: Social settings constitute the immediate physical and social
• environment where people live, learn, and interact. They include the cultural,
• economic, and interpersonal dynamics that influence human behavior.
• Components: Social settings are defined by norms (rules for behavior),
• values, and social structures like families, communities, and religious
• institutions.
• Functions: They provide social support, shape identity, and offer a
• framework for social control.Cont….
• Dimensions:
• Relationship Dimensions: Quality of personal relationships,
• involvement, and mutual support.
• Personal Growth Dimensions: The degree to which the environment
• encourages development.
• System Maintenance Dimensions: How orderly, organized, and clear

the expectations are in the environment.Organizational Settings:

Organizational Settings: An organizational setting refers to the specific, formal environment of a workplace or institution, including its hierarchy, culture, and operational rules. It is a consciously coordinated social unit aimed at achieving specific goals.

• Structural Components of Organizational Settings:
• Hierarchy: The system of power and reporting relationships.
• Specialization (Division of Labor): Dividing work into specific tasks for efficiency.
• Formalization: The degree to which rules, procedures, and communications are
• documented.
• Centralization: The concentration of decision-making authority at the top.Cont….
• Types of Organizational Structure:
• o Functional: Grouping employees by similar skills (e.g., Marketing, Finance).

o Divisional: Organizing functions around specific products, services, or locations.

o Matrix: A hybrid structure where employees report to both project and functional managers.

o Network: An organization that coordinates autonomous units and often outsources non-core functions.

• Formal vs. Informal Structures:
• o Formal Organization: Clearly defined roles and rules designed to achieve objectives.
• o Informal Organization: Automatic networks of friendships and social groups that fulfill
• psychological needs.
• Explain alternative to adherence
• Alternatives to Adherence.
• When patients struggle with adherence following
• medical advice like using eye drops or wearing
• contact lenses as prescribed optometrists use
• several strategies to ensure positive health
• outcomes:Cont….
• Involving Patients in Decision-Making: Presenting "good, better, and best" options
• helps patients choose a treatment plan they are more likely to follow, increasing
• ownership over their care.
• Simplifying Regimens: Reducing the number of times a patient has to do something
• per day, such as switching from four-times-a-day drops to once-a-day.
• Patient Education and Counseling: Using education to explain the "why" behind the
• treatment, helping them understand the risk of, for example, permanent vision loss from

glaucoma if treatment is skipped.

• Leveraging Technology: Using tools like alarms, app-based reminders, or premeasured dispensing devices to help with daily compliance.Cont….
• Concordance: This is the most patient-centered alternative. It focuses on a partnership
• where the clinician and patient negotiate to reach an agreement on treatment.
• Compliance: Historically used to describe the degree to which a patient follows a
• doctor's instructions.
• Therapeutic Alliance/Partnership: Emphasizes the relationship between the provider
• and patient, fostering trust and open communication
• Simplification & Long-Acting Therapies: Rather than requiring daily, complex actions,
• alternatives include once-daily pills, long-acting injections.Explain role of optometrist
• Optometrists are primary healthcare professionals specializing
• in eye and vision care, responsible for comprehensive eye exams,
• diagnosing diseases like glaucoma, and correcting vision with
• eyeglasses or contact lenses. They provide, manage, and treat
• various ocular conditions, including prescribing medications and
• offering pre and postoperative care.role of optometrist
• Comprehensive Eye Examinations: Conducting routine eye tests to
• check visual acuity, binocular vision, and overall eye health.
• Diagnosis and Management of Eye Diseases: Detecting early signs of
• diseases such as glaucoma, cataracts, macular degeneration, and
• diabetic retinopathy.
• Refractive Care: Prescribing eyeglasses and contact lenses to correct
• myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.Cont…
• Therapeutic Treatment: Depending on local regulations, prescribing
• medications (eye drops/ointments) for infections, inflammation, and allergies.
• Pre- and Post-operative Care: Managing care for patients before and after eye
• surgeries like LASIK or cataract surgery.
• Specialty Services: Providing vision therapy, low-vision rehabilitation for
• visually impaired patients, and fitting specialty contact lenses (e.g., for
• keratoconus).
• Systemic Disease Detection: Identifying systemic health conditions that

manifest in the eye, such as hypertension or diabetes.Explain lived experience of chronic illness

• The lived experience of chronic illness involves a
• complex, ongoing adjustment to physical, emotional,
• and social changes, often marked by grief, loss of
• control, and shifts in identity. It requires managing
• daily treatment demands, potential, and navigating a
• "new normal" that includes fatigue, pain, and, at times,
• social isolation.Lived Experience
• Emotional & Psychological Impact: Individuals often experience a
• range of emotions, including anger, anxiety, sadness, shame, and guilt.
• There is a noted "ambiguous loss“ a sense of loss without closure.
• Identity Shift: Many feel a transformation in how they view themselves,
• moving from a healthy individual to a "patient" identity, which can lead to
• feelings of decreased independence.Cont…
• Daily Management: Lives are structured around treatments, medication,
• and, at times, constant monitoring (e.g., blood sugar checks for diabetes).
• Social & Lifestyle Alterations: Chronic illness often forces disruptions in
• work, education, and social interactions, sometimes causing strain on
• relationships.
• Resilience & Adaptation: Despite challenges, many find ways to build
• resilience through self-care, social support, and shifting perspectives to

find purpose and meaning.

•Fear Of Medication And Identity Control

• Fear of medication, known as pharmacophobia, is an intense, irrational,
• or excessive fear of taking pills, shots, or other pharmacological
• treatments, often leading to avoidance.
• Aspects of Fear of Medication:
• Fear of Side Effects: Anxiety about adverse reactions, even rare ones, is
• a primary driver.
• Fear of Dependence: Worry that once treatment starts, it will be
• impossible to stop, or that the body will "need" it forever.Cont….
• Distrust of the Medical Field: Suspicion of the
• pharmaceutical industry or the medical profession.
• Past Experiences: Previous negative experiences or horror
• stories heard from others.
• Physical Phobias: Fear of the physical act of swallowing pills

(pseudo dysphagia).Identity Control

Many people, particularly those starting psychiatric medication, feel that their illness is a part of who they are, or they fear that treatment will remove their "true self".

• Loss of Self/Personality Change: Fear that medication will turn them into a different person, numb their

emotions, or cause "emotional blunting".

• Loss of Autonomy: The feeling that they are no longer in control of their own mind or body, but rather that

the pill is controlling them.

• Stigma and Shame: Perceiving the need for medication as a personal failure or weakness, which threatens

their identity as a "strong" or "functional" person.

• The "False Self" and Safety Behaviors: Some individuals, particularly those with anxiety, have developed a

"false self" designed to mask their fears. Letting go of these, even for healthier, medicated functioning, can feel like a loss of identity.Resistance To Medicine/Treatment Taking

• Resistance to medicine, or drug resistance, is the ability of
• bacteria, viruses, fungi, and parasites to withstand medications
• designed to kill them, rendering treatments ineffective. Driven
• by natural evolution, genetic mutation, and exacerbated by
• misuse or overuse of drugs, this phenomenon causes infections
• to persist, increasing the risk of spread, severe illness, and
• death.Cont….
• Mechanism: Microbes develop mutations or acquire genes that protect them from drugs.
• It is the germs that become resistant, not the human body.
• Causes: Misuse of antimicrobials (e.g., using antibiotics for viruses), not finishing
• prescribed medication, and over-prescription.
• Consequences: Common infections become difficult to treat, and critical procedures like
• surgeries, chemotherapy, and organ transplants become riskier due to the prevalence of
• "superbugs".
• Types: Resistance affects antibacterial, antifungals, antivirals, and anti-parasitic.
• Prevention: Proper, responsible use of medications and preventing the spread of

infections are critical to slowing the development of resistanceExplain patient empowerment Patient empowerment is the process of giving patients the knowledge, skills, and confidence to take control of their own health, actively participate in treatment decisions, and manage their conditions. It fosters a partnership with healthcare providers, resulting in improved health outcomes, better quality of life, and enhanced self-management.

• Aspects of Patient Empowerment:
• Active Decision-Making: Moving from passive recipient of care to an active partner in shared decision-making.
• Health Literacy & Information: Accessing and understanding information about conditions, treatment options, and costs.
• Self-Management: Gaining the skills necessary to manage chronic illnesses or post-operative recovery, such as monitoring

symptoms.

• Self-Advocacy: Feeling confident in asking questions and expressing concerns to healthcare providers.
• Support Systems: Utilizing patient education, support groups, and involving family to assist in decision-making.END OF FIVE 05

General psychology