Medication adherence is crucial for managing chronic conditions yet non-adherence is common for patients with chronic conditions. Moreover, whether or not patients can make these behaviors habitual/automatic determines if they engage in them regularly and in the long-term. In order to design, implement, and evaluate interventions to help patients develop and maintain medication-taking habits, my research attempts to do the following:
- Identify the mechanisms of long-term maintenance and habitual/automatic performance of medication taking behaviors and
- Validate appropriate measures for medication-taking habit strength
The conceptual framework of my research is an integration of existing theories that provides a comprehensive view of the entire trajectory of behavior-change relevant to medication adherence, from prescription to long-term maintenance; it specifies different factors that may impede adherence at different stages of illness management:
- Behavior development Stage 1: Treatment-favorable belief formation. With regards to medication adherence, the predictors of initiation are well studied and can be explained from the Commonsense Model of Self-Regulation (CS-SRM; Leventhal et al., 2003), which posits that all patients are ‘commonsense scientists’ and will develop illness representations when experiencing a symptom and/or receiving a medical diagnosis; the representations include beliefs about the condition’s diagnosis and associated symptoms, causal factors, control factors, duration, and consequences. This theory highlights the potential barriers to and suggests solutions for non-adherence that occurs prior to or shortly after initiation of a new regimen: if the patient perceives that no treatment is required, that the treatment has more consequences than benefits, and/or if another treatment would be better, than the provider may need to address these beliefs before the patient will try the medication (Phillips et al., 2012, BJHP).
- Behavior development Stage 2: Short-term evaluation of treatment efficacy, which leads to ‘coherent’ beliefs. With treatment-favorable beliefs, patients will continue to take their medications in the short-term—in an evaluation phase. Although relatively little research has been on this process, the CS-SRM explains the importance of this stage for long-term habit development. For example, CS-SRM research on symptom interpretation (Cameron et al, 2005) shows that individuals who experience a reduction in symptoms and attribute that reduction to the treatment, are significantly and substantially more adherent to the treatment than are individuals who perceive no improvement (or experience worsening symptoms) or who attribute any improvement to something else (e.g., rest or relaxation).
- Behavior development Stage 3: Routinization (habit formation) of treatment. After the short-term evaluation phase, if the patient determines that the medication is efficacious, the patient will ideally set up contextual cues to promote automatic, routinization of the medication regimen. For a patient to be adherent to long-term, often life-long treatment, he/she needs to develop automatic routines, or habits, for the required behaviors. Psychologists have long recognized the value of routinization of behavior (Verplanken, 2006) for freeing up the mental capacity to address new and changing circumstances and tasks—repeated, long-term tasks are most efficiently and economically given to routines that do not require attention. In the long-term, if a behavior is habitual or part of a routine, beliefs and intentions lose predictive power of the behavior (Sheeran, 2002).