Health Psychology, 2nd Edition

actions to be taken or simplifying schedules (e.g. once a day is much easier to achieve
than three times a day). Providing patients with monitoring devices such as calendars
or blister packs with named medication times also improves adherence. Thus
technological advances play a part in improving adherence. Helpful instructions can
also bolster adherence. For example, Kools (2012) found that adding illustrations to
instructions led to better recall, fewer expressed doubts, that is, enhanced self-efficacy
and a greater likelihood of correct use at first use.
Strategies that bolster memory for intentions and their subsequent enactment may
also be used to increase adherence. For example, event-based recall is better than time-
based recall (Ellis, 1998). So trying to remember ‘take antibiotics twice a day’ is likely
to be less successful than trying to remember ‘take antibiotics before breakfast and before
dinner’. If one or more intentions have to be recalled, events can be more tightly
specified, e.g. ‘take blue pill before cereal and red pill with toast at breakfast’. This is
very similar to the use of implementation intentions or if-then plans (as discussed in
Chapter 7). Memory may also be enhanced by individualized feedback. For patients
on long-term treatment medication, adherence can be monitored (e.g. by using
electronic pill containers) and combined with individualized recommendations for
remembering in relation to specific events that occur when the patient tends to forget
their medication. Such interventions have shown some success with blood glucose
control in diabetes, nebulizer use in people with obstructive lung disease, psychiatric
medication, antiretroviral medication for HIV and oral anti-diabetic tablets (Rosen et al.,
2004). Health care professionals can also assess motivation and self-efficacy. For
example, patients could be asked if they intend to follow advice and if they see any
barriers to doing so (e.g. ‘Do you think you will take these tablets four times a day over
the next two weeks?; Can you think of anything that might prevent you taking the
medication?’). Such questions provide a check on the degree to which an agreed plan
has been established and its feasibility in the context of the patient’s life.

MANAGING CONSULTATIONS

Interactions between health care professionals (e.g. doctors and nurses) and their
patients have the capacity to affect patient understanding, patient satisfaction, patient

RELATING TO PATIENTS 237

Understanding

Satisfaction Adherence

Memory

FIGURE 10.1Antecedents of adherence.

Source: Adapted from Ley, 1988.