a b s t r a c tWe describe an animated, conversational computer agent designed to promote antipsychotic medication adherence among patients with schizophrenia. In addition to medication adherence, the agent also promotes physical activity and system usage, and includes verbal and nonverbal behavior designed to foster a therapeutic alliance with patients. We discuss special considerations in designing interventions for this patient population, and challenges in developing and evaluating conversational agents in the mental health domain. Results from a pilot evaluation study of the agent indicate that it is accepted and effective.
Nonadherence to treatmeot regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.
Approximately 50% of patients across all age groups with varied types of medical conditions do not adhere to their prescribed medication regimens. Medication nonadherence is common in older adults who are often prescribed medications for age-related chronic disorders. The purpose of this paper is to investigate the effect of personal and cultural beliefs on older adults' medication adherence through a review of research studies published in journals across different disciplines. A systematic literature search using ten databases found 14 articles meeting the inclusion criteria. Belief-laden variables including self-efficacy (i.e. the belief that one can perform a specific behaviour under differing conditions), medication efficacy, confidence in the physician's knowledge, perceptions about natural products and home remedies, beliefs of control (over one's health), and illness perceptions were found to be significantly related to medication adherence among older adults. However, several measurement, design and sampling problems were identified in this review. The majority of the studies in the review evaluated older adults' medication adherence by self-report and used cross-sectional designs and convenience samples. Future studies should utilise prospective longitudinal designs and a more objective measure of medication adherence, such as electronic event monitoring, when examining factors related to older adults' medication adherence. Future research should also evaluate belief-related variables in larger and more ethnically diverse samples of older adults. Implications for assessment and intervention are evident from this literature review of the effect of personal and cultural beliefs on medication adherence in older adults.
Thirty insulin-dependent outpatients were interviewed during one of their diabetes clinic visits. Questionnaires were used to measure the independent variables of health locus of control, health value, and perceived social support. Self-report and direct observation were used to measure the dependent variable, compliance with insulin administration, diet, exercise, hypoglycemia management, self-monitoring of blood glucose (SMBG), and foot care prescriptions. All patients complied with at least 70% of the points measured; half the group complied with at least 80% of the regimen. However, no one complied with all the behaviors deemed essential for good control. The group was most compliant with SMBG, hypoglycemia management, and insulin administration and least compliant with foot care and exercise. A statistically significant relationship was found between compliance and social support (P less than 0.001), powerful others health locus of control (PHLC) (P less than 0.01), and internal health locus of control (IHLC) (P less than 0.05). A multiple regression analysis found that social support and PHLC accounted for at least 50% of the variance in compliance scores. The multiple-R of the independent variables with compliance reached a significance level of P less than 0.005. However, only the two variables of social support and PHLC added significantly (P less than 0.05) to prediction accuracy. The multiple-R of these two variables used as a set reached the significance level of P less than 0.001.
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