Advertisement

Medical Nonadherence

A Behavior Analysis
  • Carl D. Cheney
Chapter
Part of the Applied Clinical Psychology book series (NSSB)

Abstract

Imagine a 53-year-old man, Roy, who has a history of minor heart problems. He suffers from hypertension and his doctor has prescribed medication to lower his blood pressure. His doctor also suggests he schedule a medical checkup every three months. Roy faithfully takes his medication for a few weeks precisely on the prescribed daily schedule. As times goes by, however, he realizes that he does not feel any differently now than he did before, and he can also see that the medication is costing more than he cares to pay. So, Roy conveniently “forgets” to take his pills, and gradually the entire routine stops. Occasionally he experiences a period of mild chest discomfort but passes it off as indigestion. After one such episode, Roy’s wife makes him go to the hospital. The nurse in the emergency room takes his blood pressure and determines that he is supposed to be, but is not, taking his medication. Roy tells her that he sometimes forgets to take it but promises to do better in the future. The nurse gives him a few warnings and sends him home. Every 3 months, Roy’s wife reminds him to go to his scheduled appointment for a checkup. He takes his medication regularly for a week before the checkup, and the doctor, upon examining him, considers him to be doing just fine and tells him to come back again in 3 months.

Keywords

Medical Adherence Behavioral Medicine Avoidance Response Aversive Stimulus Warning Stimulus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Journal of Hospital Pharmacy. (1993). 50, 1077, 1081.Google Scholar
  2. Anger, D. (1963). The role of temporal discrimination in the reinforcement of Sidman avoidance behavior. Journal of the Experimental Analysis of Behavior, 6, 477–506.PubMedCrossRefGoogle Scholar
  3. Braus, P. (1993). Did you take your medicine? American Demographics 17(1), 14–15.Google Scholar
  4. Chance, P. (1994). Learning and behavior (3rd ed.). Pacific Grove, CA: Brooks/Cole.Google Scholar
  5. Choo, V. (1993). Business of compliance. Lancet, 342, 921.CrossRefGoogle Scholar
  6. DiMatteo, M. R., Sherbourne, C. D., Hays, R. D., Ordway, L., Kravitz, R. L., McGlynn, E. A., Kaplan, S., & Rogers, W. H. (1993). Physician’s characteristics influence patients’ adherence to medical treatment: Results from the medical outcomes study. Health Psychology, 12(2), 93–102.CrossRefGoogle Scholar
  7. Faller, N. A. (1993). (Non)Compliance. Ostomy Wound Management, 39(3), 35–38, 40, 43.Google Scholar
  8. Fantino, E. (1973). Aversive control. In The study of behavior (pp. 239–279). J. A. Nevin & G. Reynolds (Eds.), Glenview, IL: Scott Foresman.Google Scholar
  9. Feldman, M. K. (1993). Shape up! Physicians prod patients to give up bad habits. Minnesota Medicine, 76(5), 14–20.PubMedGoogle Scholar
  10. Herrnstein, R. (1969). Method and theory in the study of avoidance. Psychological Review, 76, 49–69.PubMedCrossRefGoogle Scholar
  11. Herrnstein, R., & Hineline, P. (1966). Negative reinforcement as shock frequency reduction. Journal of the Experimental Analysis of Behavior, 9, 421–430.PubMedCrossRefGoogle Scholar
  12. Irwin, C. E., Millstein, S. G., & Ellen, J. M. (1993). Appointment-keeping behavior in adolescents: Factors associated with follow-up appointment-keeping. Pediatrics, 92, 20–23.PubMedGoogle Scholar
  13. Malott, R., Whaley, D., & Malott, M. (1993). Elementary principles of behavior (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  14. Mowrer, O. H. (1947). On the dual nature of learning: A reinterpretation of “conditioning” and “problem solving.” Harvard Educational Review, 17, 102–150.Google Scholar
  15. Rachlin, H. (1989). Judgement, decision and choice: A cognitive/behavioral synthesis. New York: Freeman.Google Scholar
  16. Raynor, D. K., Booth, T. G., & Blenkinsopp, A. (1993). Effects of computer generated reminder charts on patients’ compliance with drug regimens. British Medical Journal, 306(6886), 1158–1161.PubMedCrossRefGoogle Scholar
  17. Sidman, M. (1953). Avoidance conditioning with brief shock and no exteroceptive warning signal. Science, 118, 157–158.PubMedCrossRefGoogle Scholar
  18. Sidman, M. (1989). Coercion and its fallout. Boston: Authors Cooperative.Google Scholar
  19. Skinner, B. F. (1953). Science and human behavior. New York: Free Press.Google Scholar
  20. Skinner, B. F. (1989). The origins of cognitive thought. In B. F. Skinner (Ed.) Recent issues in the analysis of behavior. (pp. 13–25). Columbus, OH: Merrill.Google Scholar
  21. Tebbi, C. K. (1993). Treatment compliance in childhood and adolescence. Cancer, 71(Suppl. 10), 3441–3449.PubMedCrossRefGoogle Scholar
  22. Trick, L. R. (1993). Patient compliance—Don’t count on it! Journal of the American Optometric Association, 64, 264–270.PubMedGoogle Scholar
  23. Trostle, J. A. (1988). Medical compliance as an ideology, Social Science Medicine, 27, 1299–1308.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Carl D. Cheney
    • 1
  1. 1.Department of PsychologyUtah State UniversityLoganUSA

Personalised recommendations