Improving medication adherence : a behavioural science approach

It is commonly assumed that the people who are making poor decisions about their health are indeed making an active decision to do so. This means that people are consciously and intentionally making poor decisions about their health. We often compute intention from action and conclude that these people are either unwilling to change their behaviour or that they are unable to do so. The default solution to changing people‘s behaviour therefore has been that since people act in their rational self-interest if we only tell people about the adverse consequences of their misbehaviour they would change it. In reality however, just giving people information does not bring about the desired behaviour change. Through insights from behavioural science, we can develop a better understanding of how and why people behave the way they do which can lead to a better informed design of health behaviour change interventions. In this PhD thesis, I aim to examine one healthcare problem where I believe the application of insights from behavioural science can create a meaningful impact. This problem relates to the issue of medication adherence. In particular, I am interested in adherence to antibiotic medication. Adherence is the extent to which the patient‘s behaviour matches agreed recommendations from the prescriber. Several reviews have found that adherence among patients in developed countries is only 50% (Horne et al, 2005; Haynes et al, 2002; WHO, 2003). Yet this figure is high in comparison with developing countries. For example, in United States, 51% of the patients with hypertension adhere to their medication. While in developing countries such as Gambia, Seychelles and China, only 27%, 26% and 43% of patients with hypertension adhere to their antihypertensive medication regimen (Bovet P et al., 2002; Graves JW., 2000; van der Sande MA et al., 2000; Guo H et al., 2001). Although adherence depends on a lot of factors, there is consistent evidence that regardless of what is being treated; non-adherence is a significant problem (WHO, 2003). The most recent systematic review on medication adherence concludes that: ―increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.‖ (Horne et al, 2005). In this PhD thesis, I therefore turn my attention to improving the effectiveness of adherence interventions.