P303 Chapter 4

P303 Chapter 4 - P303 Chapter 4 Adhering to Medical Advice...

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P303 Chapter 4 – Adhering to Medical Advice Theories that Apply to Adherence Behavioral Theory Based on Skinner’s operant condition Key to operant conditioning is the immediate reinforcement of any response that moves the person toward the target behavior (following medical advise) Reinforcement, either positive or negative, strengthen the behavior It follows o Positive Reinforcement Positively valued stimulus is added to the situation, increase probability that the behavior will recur e.g. money payment on patient’s keeping doctor appointment o Negative Reinforcement Behavior is strengthened by the removal of an unpleasant or negatively valued stimulus e.g. take medication to stop spouse from nagging o Punishment Change behavior by decreasing the chance that a behavior will be repeated Seldom useful in improving adherence it can inhibit or suppress, can condition strong negative feelings toward any person or situation associated with it. Adherence will be difficult, because learned behaviors form a pattern or habit that are resistant to change People need help in establishing changes Advocates of behavioral model use : Cues, Rewards, Contracts to reinforce compliant behaviors o Cues include written reminders, phone call, self reminders o Reward can be extrinsic (money and compliments) or intrinsic (feeling better) o Contracts can be verbal, but often written agreements Most adherence model recognize the importance of incentives in improving adherence Self-Efficacy Theory (Bandura’s) Social cognitive theory that assumes that human have capacity to exercise limited control over their lives They use their cognitive processes for self regulation Bandura suggest that human action result from an interaction of behavior, environment and person factors, especially cognition Interactive Triadic model – reciprocal determinism An important component of the person factor is – self efficacy (people’s belief in their ability to exercise measure of control over their own functioning and over environmental events) o Self-efficacy Is situation specific Refers to confidence that people can perform some behaviors to produce desired outcome, Self-efficacy can be acquired, enhanced or decreased in one of 4ways
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1. Performance 2. Vicarious experience (seeing other person with similar skills perform an act) 3. Verbal persuasion (listen to encouragement) 4. Physiological arousal state (feelings of anxiety, decrease self-efficacy) According to self-efficacy theory, people’s belief concerning their ability of initiate a
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P303 Chapter 4 - P303 Chapter 4 Adhering to Medical Advice...

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