optimists. Controlling for age and medical history and comparing those who reported
their health to be fair or poor with those who reported their health to be excellent or
very good, mortality was 8 times higher among pessimists but only 1.5 times higher
among optimists. Here optimism moderates the relationship between self-reported
health status and mortality (see Focus 5.2). More conscientious people tend to detect
symptoms earlier because they have a lower threshold for symptom detection and are
more concerned with self-protection (Feldman et al., 1999).
Personality traits can affect decisions about service usage and adherence through
specific symptom-related beliefs, that is, beliefs mediate the effect of personality on
help seeking and adherence behaviour. For example, Skinner, Hampson and Fife-
Schaw (2002) found that greater perceived consequences of diabetes symptoms and
greater perceived effectiveness of available treatment were both associated with greater
self-reported self-care among young people with diabetes. Thus, these beliefs are
important both to consulting and adherence (see Berkanovic et al., 1981 and above).
Skinner et al.(2002) found that neuroticism was associated with beliefs about the
consequences of diabetes but not with beliefs about the effectiveness of treatment. By
contrast, conscientiousness was associated with stronger beliefs in the effectiveness of
treatment. The researchers suggested that because conscientious people are more likely
to engage in active problem-focused coping (see Chapter 5) they may access more
information about their diabetes and its management, which in turn may result in more
positive beliefs about treatment effectiveness.
Collectively then, research suggests that seeking help from health professionals and
following their advice is strongly related to people’s beliefs about their symptoms or
illnesses. Consequently, understanding and intervening to change such beliefs could
lead to more cost-effective use of health services. In particular, promoting accurate
beliefs concerning the consequences of symptoms and the effectiveness of treatment
has the potential to encourage those who need help to seek it and use it optimally
and, at the same time, enable those with minor symptoms to self-manage their health.
PROMOTING ADHERENCE
‘Adherence’ means following advice given by health care professionals. This can
involve a variety of behaviour changes including taking preventive action (e.g.
reducing alcohol consumption or changing one’s diet), keeping medical appointments
(e.g. screening, physiotherapy or check-up appointments), following self-care advice
(e.g. caring for a wound after surgery) and taking medication as directed (in relation
to dose and timing). Non-adherence is usually defined as a failure to follow advice to
an extent that causes a harmful effect on health or a decrease in the effectiveness of
treatment. Most medical interventions rely on patient adherence. Yet about 50 per
cent of patients do not take prescribed medications as recommended (Myers and
Midence, 1998). This is not a new phenomenon. More than 35 years ago Sackett and
Snow (1979) reported that only half of patients on long-term medical regimens were
adherent. Across behaviours between 15 per cent and 93 per cent of patients do not
follow the advice of health care professionals (Ley, 1988) and non-adherence is
observed even when its consequences are fatal. In a prospective study of heart, liver
and kidney transplant patients, Rovelli et al.(1989) found that 15 per cent were non-
RELATING TO PATIENTS 233