in certain situations as well. For example, venipunc-
tures are common in the course of cancer treat-
ment, and this procedure can be quite distressing
to children undergoing cancer treatment, their par-
ents, and nurses who perform the procedure
(Manne et al., 1990). Manne and colleagues devel-
oped a behavioral intervention to reduce the level
of distress associated with the procedure. Its com-
ponents include attentional distraction (using a
party blower during the procedure), pacing of
breathing, positive reinforcement (e.g., receiving
stickers if the child cooperates), and parent coach-
ing. The researchers found that this intervention
package markedly reduced children’s behavioral
distress, parents’anxiety, and parents’ ratings of
child pain. Interestingly, however, this treatment
did not significantly reduce children’s self-reported
pain.
Preparation for Surgery. A sizable amount of
research has been done on ways to improve psy-
chological preparation for surgery. Similar to those
used to prepare patients for medical examinations
and procedures, interventions include (a) relaxation
strategies, (b) basic information about the proce-
dures to be used, (c) information concerning the
bodily sensations experienced during the proce-
dures, and (d) cognitive coping skills (Brannon &
Feist, 2010). For example, Wilson (1981) carried
out a well-controlled study in which intensive
training in relaxation was provided. In a sample of
700 patients undergoing either cholecystectomy
(removal of the gall bladder) or abdominal hyster-
ectomy, this relaxation intervention not only
reduced hospital stays but improved both self-
reports and physiological data.
Another technique was used with children
about to undergo surgery. It was found that a film
showing acoping model significantly reduced the
children’s emotional reactions during their time in
the hospital (Melamed & Siegel, 1975). The model
on the film was shown coping successfully with the
procedure. Those who saw the film prior to surgery
were less anxious before their operation and
showed fewer behavior problems afterward. In
general, the most effective modeling interventions
involve models who (a) are undergoing the same
procedure as the target, (b) appear initially anxious
about the procedure, and (c) successfully cope with
the anxiety and the procedure (Brannon & Feist,
2010).Compliance with Regimens
Despite the availability of intervention strategies,
the fact remains that many individuals do not com-
ply with program interventions or else do not
maintain their new behavior over any significant
period of time. It is estimated that the rate of non-
compliance with medical or health advice may be as
high as 50% (Brannon & Feist, 2010), although
there are some indications that the nonadherence
rate has improved recently. Truly successful pro-
gram strategies must generate compliance and
long-term maintenance. Both behavioral and psy-
chosocial factors must be considered.
In general, purported predictors of patient
compliance can be broken down into four catego-
ries: disease characteristics, personal characteristics
of the patient, environmental factors, and practi-
tioner–patient interaction (Brannon & Feist, 2010).
Table 17-2 summarizes research findings concerning
the relationship between a variety of factors and
patient compliance.
Educational and instructional methods have
not been particularly helpful in improving compli-
ance, but behavioral interventions have proved
more successful (Brannon & Feist, 2010). For
example, DiMatteo and DiNicola (1982) recom-
mend several general strategies to improve patient
compliance:- The use of prompts as reminders (e.g., taking
medicine before each meal, telephone calls
from providers). - Tailoring the treatment regimen to the
patient’s schedule and lifestyle. - Using written contracts that promise a reward
to the patient for complying with treatment
guidelines.
HEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 503