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Health Psychology An Introduction to Behavior and Health 8th Edition by Linda Brannon – Test Bank
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CHAPTER 2
Conducting Health Research
Lecture Outline
- The Placebo in Treatment and Research
A placebo is an inactive substance or condition that can cause people to improve or change their behavior. Both expectancy and learning contribute to this effect.
- Treatment and the Placebo
The placebo effect is an advantage for treatment, boosting its effectiveness. This effect may be responsible for about 35% of improvements, but some treatments (such as antidepressant drugs) have higher placebo effects than others (such as treatment for broken bones). Placebos can also produce negative effects, called the nocebo effect. Both placebo and nocebo effects are real and produce symptoms and relief that are indistinguishable from the effects obtained from drug and other physical treatments.
- Research and the Placebo
The placebo effect presents problems for research because they prevent a clear interpretation of treatment effectiveness. Researchers try to control for placebo effects by designing single-blind and double-blind designs, arranging for participants and even researchers to be unaware of which participants receive a placebo and which get active treatment.
- Research Methods in Psychology
For research to contribute to knowledge about health, scientists should be familiar with one another’s work, use controlled methods, try to keep personal biases from contaminating results, make claims cautiously, and replicate their studies. To understand behaviors related to health and disease, researchers use a variety of methods, including correlational studies, cross-sectional and longitudinal studies, experimental designs, and ex post facto designs.
- Correlational Studies
Correlational studies indicate the degree of relationship between two variables, such as the number of stressful life events and the risk of heart attack. This approach is one type of descriptive research. In correlational studies, the relationship between two variables is expressed in terms of correlation coefficients. Coefficients range from -1.00 to +1.00, with numbers closer to ±1.00 indicating stronger relationships. Attributions of cause and effect are not possible from correlational studies
- Cross-Sectional and Longitudinal Studies
Cross-sectional studies are conducted at one point in time and compare people of different ages, whereas longitudinal studies follow participants over an extended period of time. Cross-sectional studies can show differences between groups, but longitudinal studies can reveal developmental trends. This characteristic is an advantage of longitudinal studies, but they have the disadvantage of taking a long time and being expensive.
- Experimental Designs
Experimental designs can determine cause and effect relationships by manipulating an independent variable and observing the effect on a dependent variable, for example, comparing an experimental group on a low-fat diet (treatment group) to participants who maintain their regular diet (control group) and then measuring the development of cardiovascular disease (the dependent variable) in the two groups. Well-controlled experimental designs give scientists their best method to determine causation.
- Ex Post Facto Designs
Ex post facto designs are similar to experimental designs in that both use contrasting groups, but these designs do not include manipulation of independent variables. Instead, groups of participants differing on some subject variable (or participant variable) are contrasted to determine differences in the dependent variable. For example, contrasting people with varying levels of obesity to determine in food choices is an ex post facto study. The finding that heavier individuals express food preferences that differ from those of less obese individuals does not demonstrate that obesity is causally related to food preferences because ex post facto studies do not manipulate an independent variable or control for other factors.
III. Research Methods in Epidemiology
Epidemiology is a branch of medicine that investigates factors contributing to the occurrence of a disease in a particular population. Epidemiology evolved into a scientific discipline during the 19th century and played an important role in the fight against infectious diseases. Today, epidemiologists also study factors associated with chronic illness, including its prevalence and incidence. Prevalence is the proportion of the population affected by a particular disease at a particular time, whereas incidence is the number of new cases of a disease during a particular time, usually one year. Research methods used in epidemiology are similar to those employed by psychologists. Epidemiology research falls into three broad areas: observational methods, natural experiments, and experimental investigations.
- Observational Methods
Observational methods parallel correlation studies in psychology. The two types of observational methods are retrospective and prospective. Prospective studies are longitudinal designs that follow the forward development of a group of people starting an experience together. Retrospective studies begin with a group of people already experiencing a disease and then look for characteristics of these people that are different from those of people who do not have that disease. Retrospective studies are also called case-control studies because cases (people with a disease) are compared with controls (people not affected).
- Randomized, Controlled Trials
Randomized, controlled trials are equivalent to experiments in psychology. Clinical trials are randomized, controlled trials designed to test the effectiveness of a drug or treatment. Researchers assign participants to groups randomly to control for self-selection. Randomized, placebo-controlled double-blind designs are often considered the zenith of research design.
- Natural Experiments
Natural experiments are similar to ex post facto studies in psychology; both involve the selection rather than the manipulation of a variable. Natural experiments can be conducted when two similar groups of people naturally divide themselves into those exposed and those not exposed to a pathogen.
- Meta-analysis
The statistical technique of meta-analysis allows researchers to evaluate many research studies on the same topic, even if the research methods differed. In addition, meta-analysis provides an index of the size of the effect, which allows researchers to gauge the importance of the effect.
CHAPTER 4
Adhering to Healthy Behavior
Lecture Outline
- Issues in Adherence
Two requirements are necessary for medical advice to be beneficial; first, it must be accurate and second, it must be followed. Two meta-analyses indicate a large difference in outcome for people who were adherent to their medication compared to those who were not.
- What Is Adherence?
Adherence is a person’s ability and willingness to follow recommended health practices.
- How Is Adherence Measured?
Researchers have used at least six methods to assess patient adherence: (1) ask the practitioner, (2) ask the patient, (3) ask other people, (4) monitor medication usage, (5) examine biochemical evidence, and (6) combine two or more of these procedures. All approaches have limitations, but the least valid method is to ask the clinician about rate of patient adherence.
- How Frequent Is Nonadherence?
The rate of nonadherence to medical or health advice varies with a number of factors, but a meta-analysis of over 50 years of studies indicated that the average rate for failure to adhere was about 25%. The rate was better for some conditions such as HIV and arthritis but worse for conditions such as diabetes.
- What Are the Barriers to Adherence?
There are many barriers to that impede patients heeding physicians’ advice. Barriers include cost of medication and cost of appointments. Patients may hold an optimistic bias– a belief that they spared the negative consequences of nonadherence that afflict other people.
- What Factors Predict Adherence?
There are many factors that would logically seem to lead to adherence.
- Severity of the Disease
Severity of the disease is actually a poor predictor of adherence, but the person’s perception of severity, especially pain associated with a disease, is a better predictor of adherence.
- Treatment Characteristics
Treatment characteristics include unpleasant side effects of the medication and complexity of the treatment.
- Side Effects of the Medication
Early research found little evidence to suggest that unpleasant side effects are a major reason for discontinuing a drug or dropping out of a treatment program. Recent research indicates that patients who have concerns about severe side effects are less likely to take their medication than those individuals who do not have concerns about side effects.
- Complexity of the Treatment
In general, the greater the complexity of treatment, the lower the rate of adherence. Medication doses that cannot be cued to meals or bedtime (such as four or five doses per day) result in lower adherence than those that can. The simpler and shorter the treatment schedule, the higher the level of adherence.
- Personal Factors
Several personal characteristics relate to patient adherence.
- Age
Age shows a curvilinear relationship with adherence, with older and younger adults showing lower adherence. Older individuals have more barriers to adherence because they tend to have more complex medication schedules. Children with chronic conditions such as diabetes tend to become less compliant as they become adolescents.
- Gender
Few overall differences exist in adherence rates for women and men for most conditions, but women are more likely to adhere to a healthy diet that includes fruits and vegetables.
- Personality Patterns
No single personality trait shows any consistent relationship to adherence. Rather, nonadherence is more closely related to situational factors.
- Emotional Factors
Anxiety that is specific to the disease may improve adherence, but more general anxiety and stressful experiences tend to decrease adherence. Depression, however, presents a more serious problem for adherence. The factor of conscientiousness shows reliable relation to adherence.
- Environmental Factors
Environmental factors exert an even larger effect on adherence than personal factors do.
- Economic Factors
Income and socioeconomic status are important factors for health; those with more resources have advantages in access to health care and often have the education to understand the advantages of adherence.
- Social Support
Social support, a concept that refers to both tangible and intangible help a person receives from friends and family members, is one of the strongest predictors of adherence. People with a network of friends and family are more likely to adhere to medical advice compared with people who lack social support. People who live with someone (spouse, family, companion) are more likely to be compliant than those who live alone.
- Cultural Norms
Cultural beliefs and attitudes are related to adherence. Cultural traditions that are not consistent with Western medicine lead to lower adherence. Cultural factors and ethnicity may also influence how patients are treated; when Hispanic American and African American patients feel discriminated against, their adherence rates are not as high as when they feel treated with respect.
- Interaction of Factors
Many of the factors identified above related to adherence are not independent from one another, but, in fact, act interactively with one another. Researchers realize this and examine the complex interactions that affect adherence.
- Why and How Do People Adhere to Healthy Behaviors?
To improve people’s adherence, researchers have identified modifiable factors that predict adherence and have developed theories to understand why people make the health decisions they do. The theories of health behavior can be classified into continuum theories and stage theories.
- Continuum Theories of Health Behavior
Continuum theories are a class of theories that attempt to explain adherence with a single set of factors that should apply equally to all individuals, regardless of their motivations for adhering.
- The Health Belief Model
The health belief model includes four factors as predictors of health-related behaviors: perceived susceptibility to disease or disability, perceived severity of the disease or disability, perceived benefits of health-enhancing behaviors, and perceived barriers to health-enhancing behaviors. Overall, the health belief model does not predict adherence very well, as it emphasizes motivational factors too much and behavioral factors too little. It omits beliefs about a person’s control over a health behavior.
- Self-Efficacy Theory
Albert Bandura proposed a theory that assumes that individuals’ actions result from an interaction of behavior, environment, and person factors (such as cognition). These three concepts are referred to as reciprocal determinism. One important person factor is self-efficacy, or the belief that individuals have control of their own behavior. According to self-efficacy theory, whether an individual believes that they can do a behavior predicts whether they will have success at accomplishing that behavior. One part of this is the idea of outcome expectations, or people’s beliefs that those behaviors will produce valuable outcomes. Combining self-efficacy and outcome expectations plays an important role in predicting behavior. Self-efficacy theory has been shown to predict good adherence and good medical outcomes. A limitation of self-efficacy theory is that it concentrates on self-efficacy and omits other factors, such as social pressure or social norms.
- Theory of Planned Behavior
The theory of planned behavior posits that behavior is shaped by one’s intention to act or not act. Intentions are shaped by three factors: attitude toward the behavior, subjective norms, and perceived behavioral control. Attitude toward the behavior is one’s belief that the behavior will lead to positive or negative outcomes. The second factor that shapes intention is subjective norms, or one’s perception of the social pressure to perform or not perform the action. The third factor is perceived behavioral control, which is similar to self-efficacy. Overall, the theory of planned behavior does a good job in predicting adherence to intentional health behavior.
- Behavioral Theory
The behavioral model of adherence uses principles of operant conditioning to understand adherence. Reinforcement strengthens the behavior it follows. Positive reinforcement is when a positive stimulus is added to the situation, increase the chance the behavior will occur. Negative reinforcement is when a negative stimulus is removed and this increases the chance the behavior will occur. Punishment also can change behavior by decreasing the chances that a behavior will be repeated, however, punishment is not often used. The behavioral model often uses cues, rewards, and contingency contracts to reinforce behaviors and these have been shown to improve adherence.
- Critique of Continuum Theories
Continuum theories have generated a significant amount of research to aid in our understanding of adherence. These models do predict adherence better than chance. However, predicting behavior is challenging and past behavior is often a better predictor of future behavior than any of the beliefs or factors the continuum models identified.
- Stage Theories of Health Behavior
Stage theories propose that people pass through a series of discrete stages as they attempt to change behavior. Stage theories suggest then that people in different stages should benefit from different types of interventions and attempt to tailor information to the specific stage a person is in.
- The Transtheoretical Model
The transtheoretical model is also called stages of change model. This theory suggests that people progress (and regress) through five stages in making changes. These five stages are precontemplation, contemplation, preparation, action, and maintenance. Though this model has worked will to understand smoking cessation, it has had more limited success in predicting adherence to other behaviors. Some researchers believe that the five stages are not as distinct as the model suggests.
- The Precaution Adoption Process Model
Neil Weinstein’s precaution adoption process model assumes that when people begin new and relatively complex behaviors aimed at protecting themselves from harm, they move through as many as seven stages of belief about their personal susceptibility. In Stage 1, people are unaware of the hazard. In Stage 2, they are aware of the hazard but believe that they are not at risk but others are; that is, they have an optimistic bias. People in Stage 3 acknowledge their personal susceptibility and accept the notion that precaution would be personally effective. Action occurs in Stage 4, whereas in the parallel Stage 5, people decide that action is unnecessary. In Stage 6, people have already taken the precautions aimed at reducing risks, and Stage 7 involves maintaining the precaution. Much research has supported the notion of optimistic bias, which affects many health-related behaviors. Research on other aspects of Weinstein’s model generally supports the hypothesis that people adopt a precaution only after they see that they are personally susceptible to a hazard.
- The Health Action Process Approach
The Health Action Process Approach is a fairly new model that incorporates some aspects of both continuum theories and stage theories. There are two general stages: a motivational phase and a volitional phase. In the motivational phase, a person intends to either adopt or change a behavior and this intention is informed by a person’s risk perception, outcome expectations, and self-efficacy. The volitional phase, then, is when a person attempts to change his or her behavior, and planning is crucial step to this phase that leads to action, or behavior change (see Figure 4.5). Since this model is new, relatively few studies have been done, but the Health Action Process Approach has gained some support so far.
- Critique of Stage Theories
Stage theories have generated a significant amount of research to aid in our understanding of adherence, though the newer models of the Health Action Process Approach and Precaution Adoption Process Model have generated less research than the Transtheoretical Model. One strength of these models is that they tailor the intervention to the person’s stage of behavior change. However, they also fail to integrate other factors, such as an individual’s beliefs or perceptions.
III. The Intention-Behavior Gap
Research has shown that intention does not always lead to behavior change.
- Behavioral Willingness
Behavioral willingness refers to a person’s motivation at any given moment to engage in a risky behavior. People with strong intentions are less likely to report a willingness to engage in risky behaviors.
- Implementational Intentions
Implementional intentions are specific plans that people can make that identify not only what they intend to do, but also where, when, and how. Research has confirmed that implementation intentions are useful in promoting adherence.
- Improving Adherence
Health care providers have attempted to improve patient adherence through the use of both educational and behavioral strategies. Educational procedures that impart information boost knowledge but do not usually result in increased adherence. Behavioral strategies are more effective. These strategies include prompts that serve as reminders, such as emails or telephone calls. Tailoring the regimen to fit the patient’s schedule is another effective strategy, and the technique of motivational interviewing fits into this approach. A gradual implementation of the regimen can help shape people toward adherence, and a written contract clearly specifying behaviors for both patient and provider can be effective. Clear instructions are the single best approach to improving adherence, but combinations of techniques are even more effective in boosting adherence.
Exploring Health on the Web
Adherence to medical advice is a compelling topic for professionals, but the Internet has relatively few sites devoted to this topic.
A series of choices from healthfinder® brings you to information about prescription drugs and using them correctly. Choose health care from the main menu, then prescription drugs from the health care page. This choice delivers several dozen different types of fact sheets and tips about understanding and taking prescription medication correctly.
http://www.thehealthpages.com/articles/ar-drord.html
Contains an article, “Getting the Most From Your Doctor,” which is a consumer-oriented presentation of the statistics on nonadherence and a guide to improving your own adherence.
Suggested Activities
Personal Health Profile — What Factors Relate to Nonadherence?
Unless your students are exceptional, they fail to comply with some aspect of exemplary health behavior—that is, they are noncompliant in some way. They may fail to follow medical orders when ill, deviate from preventive health behaviors such as having regular medical check-ups, or engage in risky health behaviors such as smoking or riding with a driver who has been drinking. Therefore, almost everyone does something (or fails to do something) that meets the criterion of nonadherence, and everyone can analyze the factors that contribute to such behaviors.
Sometimes the problem is knowledge and the failure to understand what is required to follow medical advice. More often, some situational barriers prevent people from doing what they know they should do. Have your students choose a noncompliant behavior and analyze the barriers that prevent them from taking the proper action. For example, do they get enough exercise, and if not, what prevents them from doing so?
What have been the immediate consequences of their nonadherence? What will be the probable long-term consequences of their nonadherence? Do your students show signs of optimistic bias in assessing the likelihood of their consequences?
What behaviors would they be required to adopt to be compliant, and how much of a change would these behaviors present compared to their present daily routine? Do family and friends help or hinder their adherence? Is their attitude toward the practitioner who gave the recommendation a factor in their nonadherence? Has this health care professional addressed the issue of nonadherence or assumed that adherence is a given? Do they feel that they are active participants in their health care? What could make them more compliant?
Health Care Professionals’ Views of Adherence
Contrast the views of health care professionals on the topic of adherence by having your students interview a physician and a nurse about their views of patient adherence to medical regimens. Do the two types of health care professionals agree with each other concerning the frequency of nonadherence? Do their views agree with the research findings about the frequency of the problem?
How do these health care professionals rate the behavior of their own patients? Do they believe that failure to adhere to medical advice is more common among other patients than among their own?
What do these health care professionals believe is the source of failure to adhere to medical advice? Do they believe that patients fail to comply because of personality factors or situational factors?
How compliant are these professionals about healthy lifestyles? Do they smoke? Do they monitor their blood pressure and cholesterol levels? Do they wear seatbelts? Do they exercise?
Cell-Phone and Driving Use among College Students
In Chapter 16, the textbook highlights that college students are far more likely to use their cell phone while driving than other groups.
Explore the adherence rate of college students by conducting a naturalistic observation study of cell phone use while driving. Assign your students to be observers in campus parking lots and instruct them to note the frequency of cell phone use and nonuse in people driving. Attempt to get a representative sample of parking lots and times of day. With these data, you can have your students research the state and national rates of cell phone use and driving write a story for the campus newspaper. How do these figures compare to the numbers of students in the class who admit to using a cell phone while driving. Encourage the writers to focus on the number of injuries that could be prevented and the number of lives saved if all students did not use cell phones while driving.
Technology and Adherence
Technological advances have certainly been helpful in determining whether patients adhere to medication regiments (e.g., Medication Event Monitoring System). Have students brainstorm ways in which current barriers to adherence could be reduced by either using current technology or by imagining what future technology could do. What barriers could be eliminated by use of technology aids and what barriers are unlikely to be solved by technology?
Technology such as text messages can also help researchers increase adherence by reminding participants to adhere to healthy behaviors (see Prestwich, Perugini, & 2010 from the “Would You Believe…?” box). Have students think like health psychologists and design an intervention, being mindful to combine theory with technology in a meaningful way. For example, during which stage or stages of the Transtheoretical model might such an intervention be most successful for health behavior change?
Health-Related Persuasion
Most college students were not born yet in the 1980s and missed the ubiquitous “Just Say No” campaign. The following three links are from TV commercials or shows during the 1980s that tried to convince children and teens to “Just Say No” to drugs.
http://youtu.be/9Ih4tBBiPTc – Flintstone kids and Michael Jackson cartoon clip
http://youtu.be/ZIcnBccjgMw – PSA TV Commercial
http://youtu.be/H008I590stc – 1987 LA Lakers singing an anti-drug song
Have students attempt to identify psychological constructs (e.g., self-efficacy, subjective norms, attitudes) in these commercials. Though later in the text, we will discuss drug use in more detail, you may want to ask students how they would design more effective health communications—possibly by targeting different psychological constructs.
Later, anti-drug campaigns benefitted from help from major advertising professional, as part of the Partnership for a Drug Free America. This group created several slick anti-drug advertisements, including the famous “This is your brain on drugs” advertisement:
http://www.youtube.com/watch?v=3FtNm9CgA6U – This is your brain on drugs
http://www.youtube.com/watch?v=Y-Elr5K2Vuo – I learned it by watching you
http://www.youtube.com/watch?v=giGkt5oAhT0 – When I grow up
For each of these clips, have students think about a few issues. First, who is the intended audience? What constructs, from the health behavior theories described in the text, do the advertisements seem to target? Do you think the advertisements would be effective? Why or why not?
Relevant Citations:
-
- Paglia, A., & Room, R. (1999). Preventing substance use problems among youth: A literature review and recommendations. The Journal of Primary Prevention, 20(1), 3-50.
- This article summarizes the many different approaches possible to preventing drug abuse.
- Trost, M. R., Langan, E. J., & Kellar‐Guenther, Y. (1999). Not everyone listens when you “just say no”: Drug resistance in relational context. Journal of Applied Research 120-138.
- This article makes an important point that possibly students will bring up themselves after watching the PSA—it is much easier to “Just Say No” to strangers rather than close friends. How could planning (part of the HAPA model) or implementation intentions help teens be more willing to say no to friends?
- Paglia, A., & Room, R. (1999). Preventing substance use problems among youth: A literature review and recommendations. The Journal of Primary Prevention, 20(1), 3-50.
Changing People’s Health Behaviors
This chapter examines a number of psychological concepts that can be targeted in advertisements or PSA to promote adherence to health behaviors. However, often when we see popular advertisements, they don’t necessarily target psychological constructs. Have students read a research based article (see below for a possible example) that examines which psychological constructs help predict health behavior change. Then have students examine magazine advertisements or TV commercials targeting that behavior to see what type of psychological constructs are being highlighted. Finally, ask students how they would design an effective PSA to promote health behavior change.
Possible Article: Bryan, A. D., Aiken, L. S., & West, S. G. (1997). Young women’s
condom use: the influence of acceptance of sexuality, control over the sexual encounter, and perceived susceptibility to common STDs. Health Psychology, 16(5), 468-479. Found at: http://psycnet.apa.org/journals/hea/16/5/468.pdf
This article examines condom use in young women. Condom advertisements normally rely on humor or fear, and there is little research to support fear appeals, and so students should be able to find many advertisements but probably only a few that attempt to raise self-efficacy or other psychological constructs mentioned in the article.
Health Behavior Change Project
Have students pick a specific health behavior they would like to change, then have them use theories and techniques from the text to develop and implement a plan to change this behavior.
Some important components to have students include in their plans are (a) specific behavioral goals, (b) knowledge of when the behavior is most (or least) likely to occur, (c) concrete plans to change the behavior, (d) self-monitoring of the behavior, and (e) periodic evaluation of whether the plan is working.
Students can pick a health behavior early in the semester, monitor their behavior for a week or two to understand the contexts in which the behavior is most likely to occur, then use the following weeks to develop and implement their behavior change plans.
Risky Behaviors and Adolescents
Ongoing research on the brains of adolescents suggests that the brain is not fully developed during this developmental time period. PBS Frontline has a number of videos (http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain ). How does this research help explain why adolescents are more likely to engage in risky behaviors? How can we integrate this neurological knowledge to our existing knowledge on health behavior change to improve adolescent’s health behaviors?
Video Recommendations
Super Size Me (2004) is an entertaining documentary that follows one man as he consumed solely fast food for one month and documents the physical effects on his body. This film can provide a good introduction to the importance of adherence, as well as some of the environmental factors that make adherence to a healthy diet a difficult task for many people. Available for DVD rental.
From Films for the Humanities & Sciences:
Prescription Medications: A Patient’s Primer (2003) focuses on taking prescription drugs correctly. The program also presents the problem of drug interactions and stresses the importance of a cooperative relationship between patient and health care professionals.
Video from the Web:
http://www.youtube.com/watch?v=PPq_Rg9OmVI – This short lecture by Dr. Suzanne Bronheim of Georgetown University looks at the health belief model and how cultural factors may tie into each of the elements of the model. The information ties well into the textbook’s discussion of how cultural factors are typically neglected in some major models of health behavior (8:11).
Multiple Choice Questions
- The LEAST accurate method of assessing rate of adherence is to
- ask the practitioner.
- ask the patient.
- ask the patient’s family.
- monitor medication usage.
ANS: a REF: Issues in Adherence
- Patients’ records of their own rate of adherence may lack validity because
- patients sometimes lie to avoid the displeasure of their physicians.
- patients may be unaware of their own rate of adherence.
- neither a nor b
- both a and b
ANS: d REF: Issues in Adherence
- Patients’ self-reports of adherence
- are valid but not reliable.
- have questionable validity.
- are less valid than physicians’ reports.
- are more valid than examination of biochemical evidence.
ANS: b REF: Issues in Adherence
- Using hospital personnel to monitor patient adherence
- is the only currently approved method of assessing adherence.
- creates an artificial situation that may result in higher rates of adherence.
- violates regulations of the American Medical Association.
- both b and c are true.
ANS: b REF: Issues in Adherence
- The pill cap microprocessor is an improved variation of which method of assessing adherence?
- physician judgment
- patient judgment
- examination of biochemical evidence
- monitoring medication usage
ANS: d REF: Issues in Adherence
- The major advantage of the pill cap microprocessor as a means of assessing adherence is its
- cost effectiveness.
- ability to count the number of pills removed with each bottle opening.
- ability to count the number of bottle openings and record the time of day for each opening.
- nearly perfect validity.
ANS: c REF: Issues in Adherence
- Of all methods used to assess patient adherence,
- only pill count is both reliable and valid.
- examination of biochemical evidence is clearly superior.
- examination of biochemical evidence is least valid.
- no single method is sufficiently reliable or valid.
ANS: d REF: Issues in Adherence
- Economic factors may exert a negative effect on adherence by
- limiting access to screening tests.
- preventing people from getting prescriptions filled or refilled.
- increasing social support.
- both a and b
ANS: d REF: Issues in Adherence
- Which type of social support is beneficial for adherence?
- living with a family
- belonging to a large family, even one that experiences a lot of conflict
- being married
- both a and c
ANS: d REF: Issues in Adherence
- Economic factors may exert a negative effect on adherence by
- limiting access to screening tests.
- preventing people from getting prescriptions filled or refilled.
- increasing social support.
- both a and b
ANS: d REF: Issues in Adherence
- Those who do not share the cultural beliefs of Western medicine
- are just as likely as those who do to comply with the advice of a physician.
- may not comply with a physician’s advice but may comply with a practitioner from the same cultural tradition.
- are likely to be members of ethnic minorities and are less compliant than European Americans.
- are more likely to comply with the advice of a nurse than a physician.
ANS: b REF: Issues in Adherence
- Which of these personal characteristics is generally the most accurate predictor of patient adherence?
- age
- sex
- social class
- A combination of the above factors is more accurate than any one.
ANS: d REF: Issues in Adherence
- A person’s willingness and ability to follow recommended health practice is known as
- perceived behavioral control.
ANS: c REF: Issues in Adherence
- Practitioners’ accuracy when judging adherence of patients is
- very reliable.
- very valid.
- only slightly better than chance.
- the best report of patient’s adherence.
ANS: c REF: Issues in Adherence
- In a study that examined medication adherence in heart failure patients, adherence was measured by both a Medication Event Monitoring System (MEMS) and by patient self-report. ______ predicted survival over a 6-month period, whereas ______ did not.
- Patient self-report; MEMS
- MEMS; patient self-report
- Practitioner self-report; MEMS
- Exercise; MEMS
ANS: b REF: Issues in Adherence
- Some chronic conditions, such as HIV and arthritis, show _____ adherence rates where diabetes and pulmonary disease show ______ adherence.
- low; high
- high; low
- low; low
- high; high
ANS: b REF: Issues in Adherence
- Angela is a heavy smoker and knows that smoking increases one’s chances of lung disease. However, she believes that she is not at an increased risk for lung cancer. This is because Angela has a(n) _____________.
- high self-efficacy
- high self-esteem
- optimistic bias
- pessimistic bias
ANS: c REF: Issues in Adherence
- For individuals who are depressed, their risk of nonadherence is ____ greater than individuals who are not depressed.
- four times
- five times
- two times
- three times
ANS: d REF: Issues in Adherence
- _______ is the concept that refers to tangible and intangible help a person receives from friends and family.
- Self-efficacy
- Self-esteem
- Social support
- Self-concept
ANS: c REF: Issues in Adherence
- In studies with patients recovering from heart problems and patients with diabetes, _________ was a better determinant of adherence than ______________.
- practical support; emotional support
- emotional support; invisible support
- emotional support; practical support
- practical support; invisible support
ANS: a REF: Issues in Adherence
- Older studies found a general rate of nonadherence around _______; more recent studies show a rate of about _______.
- 25% . . . . 50%
- 50%. . . . 25%
- 75% . . . over 90%
- 10% . . . . nearly 40%
ANS: b REF: Issues in Adherence
- The following disease characteristic is the MOST accurate predictor of patient adherence:
- severity of the disease as seen by the attending physician
- patient’s perception of the severity of the disease
- severity of the medication’s side effects
- a medication with no side effects
ANS: b REF: What Factors Predict Adherence?
- Nonadherence rises abruptly when the prescription requires the patient to take one pill
- once a day.
- twice a day.
- three times a day.
- four times a day.
ANS: d REF: What Factors Predict Adherence?
- The relationship between adherence and age is complex. For example, one study (Thomas et al., 1995) found that age had a(n) ______ relationship with adherence to colorectal screening.
- inverse
- direct
- curvilinear
- dose response
ANS: c REF: What Factors Predict Adherence?
- With regard to age, studies show that nonadherence
- increases with age.
- decreases with age.
- has a curvilinear relationship with age.
- is not related to age.
ANS: c REF: What Factors Predict Adherence?
- Women are more likely than men to show higher rates of adherence to a
- medication for high blood pressure.
- physical activity program.
- smoking cessation program.
- healthy diet.
ANS: d REF: What Factors Predict Adherence?
- With regard to gender, which of these statements most clearly agrees with research?
- Women are more likely than men to comply with dietary recommendations.
- Women are generally more likely than men to comply with all medical recommendations.
- Men are more likely to be extremely resistant to taking medication.
- Women are more likely to be extremely resistant to taking medication
ANS: a REF: What Factors Predict Adherence?
- The noncompliant personality
- has not been found to exist.
- is more common among men than among women.
- is less common among well-educated people.
- is more common among the elderly.
ANS: a REF: What Factors Predict Adherence?
- Research indicates that people who are compliant in one situation
- tend to be compliant in other situations.
- tend to be noncompliant in other situations.
- may or may not be compliant in other situations.
- will discontinue compliant behavior when they change physicians.
ANS: c REF: What Factors Predict Adherence?
- People who experience high levels of stress
- become more adherent to medication routines oriented toward controlling their stress.
- become less adherent to medications for chronic conditions but not for short-term problems.
- become more likely to adhere.
- become less likely to adhere.
ANS: d REF: What Factors Predict Adherence?
- The effects of anxiety on failure to comply are ______, and the effects of depression are _____.
- small . . . also small
- small . . . large
- large . . . also large
- large . . . small
ANS: b REF: What Factors Predict Adherence?
- In Stage 2 of the precaution adoption process model, people are aware of a hazard, but they believe that others are at risk, and they are not. This attitude is called
- an optimistic bias.
- a pessimistic bias.
- a rationalization.
- the ostrich effect.
ANS: a REF: Why and How do People Adhere to Healthy Behaviors?
- The behavioral model of adherence
- emphasizes reinforcement of compliant behaviors.
- emphasizes punishment of noncompliant behaviors.
- includes the concept of subjective norms.
- has very little supporting evidence.
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- An adherent patient who reduces her pain by taking prescribed medication as scheduled is an example of
- classical conditioning.
- negative punishment.
- positive reinforcement.
- negative reinforcement.
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- Negative reinforcement _____ behavior.
- strengthens
- weakens
- punishes
- both b and c
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- Research conducted on the adherence of children with asthma revealed that
- behavioral techniques were largely ineffective.
- behavioral techniques were effective, but the lack of an educational component was a drawback.
- the children named rewards as the most effective approach.
- children responded to rewards but adolescents did not.
ANS: c REF: Why and How Do People Adhere to Healthy Behaviors?
- Dawson’s dentist calls to remind him of his scheduled appointment in three days. When Dawson arrives at the dentist’s office he is permitted to select a lottery ticket as a reward for keeping his appointment. From this information, it appears that Dawson’s dentist is using an approach based on the _______ model of adherence.
- health belief
- self-efficacy
- theory of reasoned action
- behavioral
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- Bandura’s notion of reciprocal determinism assumes that human conduct results from an interaction of behavior, person factors (such as cognition), and
- the environment.
- outcome expectancies.
- a person’s subjective norms.
- intention to act.
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- Self-efficacy refers to
- people’s belief that they can perform those behaviors necessary to bring about control over events that influence their lives.
- people’s belief that their particular lifestyle is a healthy one even when it is not.
- people’s belief that a course of action will result in an ideal state of physical and psychological health.
- people’s attitude toward the inevitability of disease and death.
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- Research on smoking relapse, adherence to an exercise regimen, and adherence to diabetic diet has shown that
- those with high self-efficacy quickly relapsed.
- those with high self-efficacy were more likely to be adherent.
- self-efficacy has a negative correlation with adherence.
- self-efficacy is an advantage for smoking relapse but is not important for exercise or diet.
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- Morton is 90 pounds overweight and has both high blood pressure and high serum cholesterol. However, it has never occurred to Morton that he might be a candidate for cardiovascular disease if he does not change his lifestyle. According to Prochaska’s transtheoretical theory, Morton is in the _____ stage.
- precontemplation
- maintenance
- contemplation
- final
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- Gina smokes two packs of cigarettes a day, but lately she has begun to seriously think about quitting. According to the transtheoretical model, Gina is in the _____ stage.
- precontemplation
- contemplation
- action
- maintenance
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- The transtheoretical model of James Prochaska and his colleagues assumes that people go through five stages in making changes in their behavior. What is the proper order of these changes?
- precontemplation, contemplation, preparation, action, and maintenance
- preparation, precontemplation, self-efficacy, intention to act, and action
- intention to act, contemplation, preparation for action, action, reaction
- intention to act, contemplation, preparation for action, action, relapse
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- For the past three years, Loran has been following his doctor’s advice to cut down on his consumption of red meat and to eat more fruits and vegetables. With regard to protecting himself against heart disease, Loran is currently in which stage of the transtheoretical model?
- precontemplation
- contemplation
- maintenance
- preparation
ANS: c REF: Why and How Do People Adhere to Healthy Behaviors?
- Central to the transtheoretical model is the assumption that both behavior change and relapse take the shape of a
- triangle.
- rectangle.
- cone.
- spiral.
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- According to the transtheoretical model, relapse
- is most likely during the maintenance stage.
- is most likely during the action stage.
- is possible during any stage.
- is unlikely past the action stage but more likely in earlier stages.
ANS: c REF: Why and How Do People Adhere to Healthy Behaviors?
- __________ of health behavior take(s) a “one size fits all” approach.
- Stage theories
- Continuum theories
- Response efficacy
- Stages of change
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- The model or theory that includes four beliefs—perceived susceptibility, perceived severity, perceived benefits, and perceived barriers—to predict health-related behavior is the
- self-efficacy theory.
- health belief model.
- health action process approach.
- theory of planned behavior.
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- In the health belief model, the belief that relates to an individual’s perceived risk to the disease is
- perceived susceptibility
- perceived severity
- perceived benefits
- perceived barriers
ANS: a REF: Why and How Do People Adhere to Healthy Behaviors?
- In the health belief model, the belief that relates to whether an individual faces obstacles to health-enhancing behaviors is
- perceived susceptibility
- perceived severity
- perceived benefits
- perceived barriers
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- The best predictors of health-related behavior in the health belief model are
- perceived susceptibility & perceived barriers
- perceived severity & perceived barriers
- perceived benefits & perceived severity
- perceived barriers & perceived benefits
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- _____ refer(s) to people’s confidence that they can perform a behavior to produce a desired outcome in a particular situation.
- Self-esteem
- Self-efficacy
- Outcome expectations
- Perceived benefits
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- The model or theory that suggests that behavior is shaped by one’s intention to act or not act, and that intentions are shaped attitudes, subjective norms, and perceived behavioral control is
- self-efficacy theory.
- health belief model.
- health action process approach.
- theory of planned behavior.
ANS: d REF: Why and How Do People Adhere to Healthy Behaviors?
- _____ is an individual’s perception of the social pressure to perform or not perform an action.
- Self-efficacy
- Perceived behavioral control
- Subjective norm
- Attitude
ANS: c REF: Why and How Do People Adhere to Healthy Behaviors?
- _____ is an individual’s perceptions of how much control exists over one’s behavior, and is one factor that determines intentions in the theory of planned behavior.
- Self-efficacy
- Perceived behavioral control
- Subjective norm
- Attitude
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
- The theory of planned behavior predicts ___________.
- risky health behaviors
- intentional health behaviors
- unconscious health behaviors
- none of the above
ANS: b REF: Why and How Do People Adhere to Healthy Behaviors?
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