It seems behaviour change and adherence are challenging no matter what we are talking about, whether it's taking a medication, following an exercise regimen, sticking to a diet or quitting smoking. Some of our learned behaviours and habits have to be modified and this is difficult for us to do as humans. Two sessions on adherence reinforced that allied health professionals have a lead role in helping to promote adherence.
The first session was a health professional abstract review where Lurdes Barbosa discussed her study on medication adherence in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The aim of the study was to look at the reasons for non-adherence to medications using a qualitative 4-point scale. Of the 105 patients enrolled, 81% had RA and 19% had PsA. The overall non-adherence rate was 60%. The main reasons for lower adherence were forgetfulness and fear of side effects. Younger age was independently associated with medication non-adherence.
Recommendations to address non-adherence include reminders for medications as part of the treatment plan. Allied health professionals play an important role in terms of education and communication to decrease barriers to taking medications, and they also have the opportunity to "check in" with patients to encourage adherence.
During an abstract session on exercise adherence, Sebastiaan Hillberkink presented a talk on "Action planning parameters for effectiveness in increasing exercise adherence behaviour." We know that higher adherence to exercise programs has beneficial effects on disease outcomes, however, getting patients to actually do the exercise is the difficult part. Action planning can help promote exercise adherence but up until now, the parameters for action planning have been unclear.
His study looked at different parameters to see which ones influenced exercise adherence the most. Among the parameters evaluated were behavioural intentions, coping planning, self-efficacy, and confidence in plans. Patients received a home exercise program and then were asked about their intentions to follow the program and their self-efficacy. Action planning and intentions were both found to predict exercise adherence. Interactions between the various parameters were a little more complicated. When intentions to exercise decreased, the action planning conversely increased to compensate. When they looked at intentions and coping planning, they found that action planning was more effective when intentions were lower and not combined with coping planning. Therefore, use action planning to increase adherence for patients with lower behavioural intentions but do not combine action planning with coping planning.
This might sound confusing but what I took home from this was that if you use coping strategies to focus on a patient's barriers, it may be too much to work on all of them at once. Keep it simple. Focus on what the patient can do. Set an action plan and re-assess to monitor adherence. For those of us who took psychology in undergraduate school, it goes back to what we learned about behaviour modification – focus on reinforcing positive behaviours.