Posted: April 24th, 2025

Healthy Behaviors

Barriers to Adherence: What are some common barriers that you’ve encountered in your experience or research? How do these barriers vary between different patient populations?

Role of Technology: How can technology, such as mobile health apps or electronic reminders, contribute to better adherence? Are there any potential drawbacks to these technologies?

short response 100 words total

Chapter 4

Adhering to Healthy Behavior

Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1
©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chapter Objectives
(1 of 3)
By the end of this chapter, you should be able to…
Define adherence, and understand the strengths and limitations of different ways of measuring adherence
Understand how the frequency of nonadherence relates to the type of health condition, as well as common barriers to adherence
Understand how medical factors, such as the severity of a disease and characteristics of a medical treatment, affect adherence
Understand how personal factors such as age, gender, and personality relate to adherence

Chapter Objectives
(2 of 3)
Understand how environmental factors such as socioeconomic status, social support, and cultural context relate to adherence
Understand the difference between continuum theories and stage theories of health behavior, and what they assume about how people change in adherence to health behaviors.
Identify the key factors in continuum theories, such as the health belief model, self-efficacy theory, the theory of planned behavior, and behavioral theory
Identify the key factors and stages of stage theories, such as the transtheoretical model and the health action process approach.

Chapter Objectives
(3 of 3)
Recognize how two factors – behavioral willingness and implementational intentions – can help explain why some intentions translate into action, whereas other intentions do not
Understand the difference between educational and behavioral strategies in improving adherence
Identify several behavioral strategies that have been used to improve adherence

Issues in Adherence
4.1

Adherence and Nonadherence
Adherence is defined as a person’s ability and willingness to follow recommended health practices; or the extent to which a person’s behavior coincides with medical or health advice.
Adherence can be measured several ways, including asking the patient, asking the medical professional, asking others who are around the patient, monitoring their medication use, medical tests, and any combination of these.
There are approximately 25% of patients who do not adhere to medical advice from a medical professional. Of note, taking medication has the highest rate of adherence, while lifestyle changes like getting exercise have the lowest.

Barriers to Adherence
When it comes to adherence, there are several barriers that may lead an individual into nonadherence. Issues like cost, time, optimistic bias, and more can have a negative impact on how well somebody decides to follow the directions provided by the medical professional. These failures to adhere can have severe consequences depending on the reason for the medical advice.

What Factors Predict Adherence?
4.2

Adherence Predictions
(1 of 2)
In general, those people with a serious disease will be more likely to see out medical treatment. In some cases it will be the patient’s perception of how serious the disease is.
Another significant factor that may determine whether they follow medical advice are the characteristics of the treatment itself. For example, adherence drops to 40% when a patient has to take four or more doses of a medication. Side effects of treatment can also hinder somebody willingness to adhere to the prescribed regimen.
Additional factors affecting adherence include age and gender. We’ve seen in previous chapters that as somebody gets older, they’re more likely to seek treatment. This also holds true with adherence. The same trend is also seen with women being more likely to adhere to medical instructions than men.

Adherence Predictions
(2 of 2)
There are also short-term predictors around adherence. An example of this revolves around stress and emotional problems. The more stress a person is under, the more likely it is that they will either not adhere, or their adherence will be reduced.
Those who suffer anxiety and depression also tend to have issues around adherence. While there is a noticeable trend in non-adherence with anxiety, it’s a relatively small downward trend, whereas those who suffer depression tend to have a far more difficult time adhering to medical advice.
Finally, environmental factors like having a social support network, income, and cultural norms can determine whether somebody will follow adherence advice from a medical professional; as well as any joint interaction between all the non-adherence factors.

Why and How Do People Adhere to Healthy Behaviors?
4.3

Continuum Theories of Health Behavior
(1 of 5)
Overall Strengths
Has produced substantial amounts of research to help understand theories
Identify beliefs that should motivate anyone to change his or her behavior
All models are better than chance at predicting behavior

Overall Weaknesses
Some theories are better at predicting intentions than behaviors
Rely heavily on self-report
Leave out important factors such as self-identity and emotions

Continuum Theories of Health Behavior
(2 of 5)
The continuum theories of Health Behavior contain several different approaches with various strengths and weaknesses. The Health Belief Model focuses on the individual’s perceived views as to their susceptibility and severity of disease, as well as their perceived benefits and barriers to health enhancing behaviors.
The Health Belief Model can predict simple health behaviors accurately, but it cannot predict adherence very well, nor does it consider personal control.

Continuum Theories of Health Behavior
(3 of 5)

The Self-Efficacy Theory focuses on the idea that people can exercise limited control over their lives. Bandura’s idea of reciprocal determinism states that people’s actions are the results of behavior, environment, and personal factors, especially their beliefs. This theory has resulted in the ability to predict adherence to a variety of health recommendations, but it focuses mainly on self-efficacy and omits other factors.

Continuum Theories of Health Behavior
(4 of 5)
The Theory of Planned Behavior focuses on three factors that shape intention. First, there’s the attitude toward the behavior, whether that’s positive or negative; second is the perceived control one has over their own behavior; and third are the subjective norms shaped by his or her belief that other people encourage the behavior. While this theory is decent at predicant physical activity and dietary behaviors, it’s not as good at predicting risky behavior.

Continuum Theories of Health Behavior
(5 of 5)
The Behavioral Theory of health behavior focuses heavily on the idea of operant conditioning. Reinforcement will strengthen behavior while punishment decreases behavior.
The rewards/reinforcement aspect has been shown to be especially effective in children, while the punishment model has not proven to be useful in improving people’s behavior.

Stage Theories of Health Behavior
(1 of 3)
Strengths
Recognize the benefits of tailoring interventions to a person’s stage of behavior change

Weaknesses
More complex than continuum theories; may be unnecessarily complex
Need longitudinal research to study people throughout the stages

Stage Theories of Health Behavior
(2 of 3)
Transtheoretical Model (Prochaska and colleagues, 1992) suggests that people progress and regress through five stages; precontemplation, contemplation, preparation, action, and maintenance. While this model does provide some insight into behavioral changes, it doesn’t do a good job of predicting adherence.

The Health Action Process Approach (Schwarzer, 2008) incorporates aspects of both continuum theories and stage theories. It looks at two general stages; the Motivational Stage, which includes outcome expectations, risk perceptions, self-efficacy, and intention; and the Volitional Stage, which includes planning and action. This theory considers planning, though it also requires more study as it is one of the newest theories regarding Health Behavior.

Stage Theories of Health Behavior
(3 of 3)

The Intention-Behavior Gap
4.4

Intention-Behavior Gap
Research into whether a person’s intentions can predict their behavior have shown that people may intend to behave a certain way, but do not follow through.
Behavioral Willingness is a person’s motivation at a given moment to engage in risky behavior. What this essentially means is that while somebody may have the intention of behaving a certain way, those intentions are forgotten in the moment. Teenagers are especially prone to behavioral willingness and frequently engage in more risky behaviors than adults.
A way that people can help meet their intentions is by implementation intentions, which include specific plans people make to to meet their intentional goals.

Improving Adherence
4.5

Behavioral Strategies
The push for better adherence rates in individuals has been happening since the first piece of medical advice was ever offered. The best we can do right now is offer strategies that may help patients adhere to medical advice more closely. Behavioral strategies such as using prompts, tailoring a regimen to the patient, using a graduated regimen implementation, and even using a contingency contract. Any of these, or perhaps a combination of them, could potentially help somebody better adhere to medical advice.
The unfortunate fact that we must face is that no matter how much work is put into rising adherence rates, those rates haven’t improved much in over fifty years.

Self-Assessment
When reading this chapter, what were some of the hardest concepts to grasp? For example, is it hard for you to understand why some people do not adhere to medical advice? Is it hard for you to understand why people persist in unhealthy behavior? Why or why not?
Consider ways you may be able to help yourself do a better job in following through with your intentions. What strategies do you feel would work best on you? Do you know anybody who might need a different approach under similar circumstances?

24
©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Summary

Summary
(1 of 3)
Now that you’ve completed this chapter, you should be able to:
Define adherence, and understand the strengths and limitations of different ways of measuring adherence
Understand how the frequency of nonadherence relates to the type of health condition, as well as common barriers to adherence
Understand how medical factors, such as the severity of a disease and characteristics of a medical treatment, affect adherence
Understand how personal factors such as age, gender, and personality relate to adherence

Summary
(2 of 3)
Understand how environmental factors such as socioeconomic status, social support, and cultural context relate to adherence
Understand the difference between continuum theories and stage theories of health behavior, and what they assume about how people change in adherence to health behaviors.
Identify the key factors in continuum theories, such as the health belief model, self-efficacy theory, the theory of planned behavior, and behavioral theory
Identify the key factors and stages of stage theories, such as the transtheoretical model and the health action process approach.

Summary
(3 of 3)
Recognize how two factors – behavioral willingness and implementational intentions – can help explain why some intentions translate into action, whereas other intentions do not
Understand the difference between educational and behavioral strategies in improving adherence
Identify several behavioral strategies that have been used to improve adherence

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