Wednesday, 3 February 2016
Outline One Piece Of Research Into Measuring Adherence
One piece of research into measuring adherence is Chung and Naya where they electronically assess compliance and adherence with an oral asthma medication in a field experiment. They used 57 asthmatic patients however only 47 patients completed the study. The participants began 12 weeks of treatment to be take twice daily, 8 hours apart. Adherence was measured by the TrackCap objectively recording each occasion that patients removed and replaced their medication bottle caps. Medicine was supposed to be taken two times a day. Adherence was measured by the TrackCap objectively recording each occasion the patients removed and replaces their bottle caps, this provides frequency and length of time between openings which should be 8 hours apart. 47 patients completed the study with a mean compliance of 80% and an adherence of 64% as measure by the TrackCap events. High rates of compliance were measured throughout the trial. The results show that compliance with and adherence to a treatment of an oral, asthma medication is high. The evidence supports the concept of measuring adherence as the compliance and adherence to a treatment of asthma medication is high.
Tuesday, 2 February 2016
Measuring Adherence- (Chung and Naya)
Chung and Naya
Aim: To electronically assess compliance/ adherence with an oral asthma medication.
Method: Field experiment
Participants: 57 asthmatic patients (47 completed it).
Procedure: Patients were told that compliance would be assessed as part of the study however they weren't told about the specifics of the TrackCap. The participants began 12 weeks of treatment with oral asthma medication (pills) to be taken two times a day. Adherence was measured by the TrackCap objectively recording each occasion that patients removed and replaced their bottle caps. The TrackCap recorded each time a patient opened their bottle this provided the researcher with the number of times they opened the bottle and length of time between openings.
The medicine was suppose to be taken twice a day, so a patient was seen to be adhering if the TrackCap was opened twice a day with 8 hours in-between each opening.
Results: 47 patients completed the study with a mean compliance of 80% (compliance being 1- TrackCap openings per number of tablets the patient was told to take and 2- as the difference between number of tablets dispensed and number returned per number prescribed)
E.g. say if patient prescribed 50 tablets, dispenses 42, therefore would be returning 8.
Mean adherence of 64% (adherence defined as the number of days with two TrackCap events at least 8 hours apart as measured by TrackCap events. High rates of compliance were maintained throughout the trial. Compliance as estimated from return tablet count was slightly higher.
Discussion: The results show that compliance with and adherence to a treatment of an oral, twice daily, maintenance asthma medication is high.
Concept:
Even if its assumed that adherence rates are low, psychologists still ned to consider how adherence can be measured. There are ways of measuring adherence and, as in all psychological research, no perfect research method.
Self-report: Ask the patient and they may tell you how adherent they are. Unfortunately it is a consistent research finding that patients overestimate their adherence to the treatment.
Therapeutic outcome: Is the patient getting better? If, for example a patient is taking the medication for hypertension then we would expect their blood pressure to decrease. However there are a range of factors the could contribute to a change in blood pressure such as an environment change and levels of stress,
Health worker estimates: Ask the doctor and they should be able to estimate how adherent a patient is being. Once again, this method has been found to be very unreliable.
Mechanical methods: A number of devices that have been developed to measure how much medicine is dispensed from a bottle. These devices are expensive and only record how much medicine leaves the bottle and not how much goes into the person.
Biochemical tests: It is possible to use a blood test or urine sample to estimate how adherent a patient has been with their medication. For example, it is possible to estimate adherence with diet in renal patients by measuring the potassium and urea in their blood when they report for their next session of dialysis.
Evaluation:
The sample must have volunteered which makes it ethical. However the sample was ethnocentric as the patients were only from London and may naturally have high adherence as they volunteered to take part. It should be noted not all completed the study, only 47/57 did.
Validity: Slight use of deception- avoids demand characteristics. Conducted over 12 week period which would allow for initial socially desirable behaviours to wear off. Objective measurement
Aim: To electronically assess compliance/ adherence with an oral asthma medication.
Method: Field experiment
Participants: 57 asthmatic patients (47 completed it).
Procedure: Patients were told that compliance would be assessed as part of the study however they weren't told about the specifics of the TrackCap. The participants began 12 weeks of treatment with oral asthma medication (pills) to be taken two times a day. Adherence was measured by the TrackCap objectively recording each occasion that patients removed and replaced their bottle caps. The TrackCap recorded each time a patient opened their bottle this provided the researcher with the number of times they opened the bottle and length of time between openings.
The medicine was suppose to be taken twice a day, so a patient was seen to be adhering if the TrackCap was opened twice a day with 8 hours in-between each opening.
Results: 47 patients completed the study with a mean compliance of 80% (compliance being 1- TrackCap openings per number of tablets the patient was told to take and 2- as the difference between number of tablets dispensed and number returned per number prescribed)
E.g. say if patient prescribed 50 tablets, dispenses 42, therefore would be returning 8.
Mean adherence of 64% (adherence defined as the number of days with two TrackCap events at least 8 hours apart as measured by TrackCap events. High rates of compliance were maintained throughout the trial. Compliance as estimated from return tablet count was slightly higher.
Discussion: The results show that compliance with and adherence to a treatment of an oral, twice daily, maintenance asthma medication is high.
Concept:
Even if its assumed that adherence rates are low, psychologists still ned to consider how adherence can be measured. There are ways of measuring adherence and, as in all psychological research, no perfect research method.
Self-report: Ask the patient and they may tell you how adherent they are. Unfortunately it is a consistent research finding that patients overestimate their adherence to the treatment.
Therapeutic outcome: Is the patient getting better? If, for example a patient is taking the medication for hypertension then we would expect their blood pressure to decrease. However there are a range of factors the could contribute to a change in blood pressure such as an environment change and levels of stress,
Health worker estimates: Ask the doctor and they should be able to estimate how adherent a patient is being. Once again, this method has been found to be very unreliable.
Mechanical methods: A number of devices that have been developed to measure how much medicine is dispensed from a bottle. These devices are expensive and only record how much medicine leaves the bottle and not how much goes into the person.
Biochemical tests: It is possible to use a blood test or urine sample to estimate how adherent a patient has been with their medication. For example, it is possible to estimate adherence with diet in renal patients by measuring the potassium and urea in their blood when they report for their next session of dialysis.
Evaluation:
The sample must have volunteered which makes it ethical. However the sample was ethnocentric as the patients were only from London and may naturally have high adherence as they volunteered to take part. It should be noted not all completed the study, only 47/57 did.
Validity: Slight use of deception- avoids demand characteristics. Conducted over 12 week period which would allow for initial socially desirable behaviours to wear off. Objective measurement
Explanations Of Dysfunctional Behaviour- Cognitive (Beck et al 1974)
The cognitive approach assumes that dysfunctional behaviour is due to fault processing of information and this leads to distorted thinking and behaviour.
Key study: Interviews with patients undergoing therapy for depression.
Aim: To understand cognitive distortions in patients with depression
Method: Clinical interviews.
Participants: 50 patients diagnosed with depression (16 male, 34 female).
Design: Independent measures: patients compared to non depressed patients. Matched for age, sex, class.
Procedure: Interviews and retrospective reports of patients thoughts before session (from diaries) and during session. Records kept of verbalisations.
Findings: Differences in non depressed patients compared to depressed patients: Low self esteem, paranoia, greater anxiety.
Conclusion: Depressed patients have cognitions that are untrue and illogical.
Key study: Interviews with patients undergoing therapy for depression.
Aim: To understand cognitive distortions in patients with depression
Method: Clinical interviews.
Participants: 50 patients diagnosed with depression (16 male, 34 female).
Design: Independent measures: patients compared to non depressed patients. Matched for age, sex, class.
Procedure: Interviews and retrospective reports of patients thoughts before session (from diaries) and during session. Records kept of verbalisations.
Findings: Differences in non depressed patients compared to depressed patients: Low self esteem, paranoia, greater anxiety.
Conclusion: Depressed patients have cognitions that are untrue and illogical.
Explanations Of Dysfunctional Behaviour- Biological (Gottesman and Shield)
Key study: Review of adoption, twin and family studies of schizophrenia.
Method: Review of adoption/ twin studies (1967- 76) 3 adoption studies and 5 twin studies.
Participants: 711 from adoption studies and 511 from twin studies.
Procedure: Incidences of schizophrenia analysed from various studies.
Adoption studies: adoptive parents and siblings, compared to biological parents and siblings.
Twin studies: Concordance rate for monozygotic and dizygotic twins compared.
Findings: Increased incidence of schizophrenia in adopted children with schizophrenic biological parent. Higher concordance rate for schizophrenia in monozygotic twins (58% compared to 12% with dizygotic twins)
Conclusion: Significant genetic influence- schizophrenia (but not 100%).
Method: Review of adoption/ twin studies (1967- 76) 3 adoption studies and 5 twin studies.
Participants: 711 from adoption studies and 511 from twin studies.
Procedure: Incidences of schizophrenia analysed from various studies.
Adoption studies: adoptive parents and siblings, compared to biological parents and siblings.
Twin studies: Concordance rate for monozygotic and dizygotic twins compared.
Findings: Increased incidence of schizophrenia in adopted children with schizophrenic biological parent. Higher concordance rate for schizophrenia in monozygotic twins (58% compared to 12% with dizygotic twins)
Conclusion: Significant genetic influence- schizophrenia (but not 100%).
Explanations Of Dysfunctional Behaviour- Behavioural (Watson and Raynor)
Three approaches:
Behavioural:
Dysfunctional behaviour learnt by:
Classical conditioning (Watson and Raynor)
Operant Conditioning (skinner)
Social Learning (Bandura)
Watson and Raynor
Aim: To see if a fear response can be conditioned in a baby by a previously neutral stimulus.
Method: Case study (in controlled lab conditions)
Participant: Little Albert, 8 month old, unemotional. No fear response to a rat, rabbit, monkey, coat, mask, newspaper on fire, but alarmed by a steel bar hit by a hammer.
Procedure: Five sessions over several weeks.
Sessions 1 and 2: Albert presented with rat and steel bar struck. Progressively, rat presented without loud noise and Albert would cry and crawl away.
Sessions 3 and 4: Albert presented with rat, then rabbit, dog mask, cotton wool and santa mask. Fear is transferred.
Session 5: One month later- tested with various stimuli; Fear response still present.
Conclusion: Fear response learnt by classical conditioning.
- Behavioural
- Biological
- Cognitive
Behavioural:
Dysfunctional behaviour learnt by:
Classical conditioning (Watson and Raynor)
Operant Conditioning (skinner)
Social Learning (Bandura)
Watson and Raynor
Aim: To see if a fear response can be conditioned in a baby by a previously neutral stimulus.
Method: Case study (in controlled lab conditions)
Participant: Little Albert, 8 month old, unemotional. No fear response to a rat, rabbit, monkey, coat, mask, newspaper on fire, but alarmed by a steel bar hit by a hammer.
Procedure: Five sessions over several weeks.
Sessions 1 and 2: Albert presented with rat and steel bar struck. Progressively, rat presented without loud noise and Albert would cry and crawl away.
Sessions 3 and 4: Albert presented with rat, then rabbit, dog mask, cotton wool and santa mask. Fear is transferred.
Session 5: One month later- tested with various stimuli; Fear response still present.
Conclusion: Fear response learnt by classical conditioning.
Biases In Diagnoses (Ford And Widiger)
Ford and Widiger investigated sex biases in Diagnoses of Disorders.
Method: Self-report
Participants: 354 clinical psychologists, randomly selected from the national register in 1983.
Procedure: Participants were given one of 9 case studies, patients with Anti-social Personality Disorder, Histrionic Personality Disorder, or a mixture of both.
They diagnosed each case study on a 7 point likert scale according to the disorder. (E.g. Narcissistic, anti-social, alcohol abuse).
Findings: ASPD was correctly diagnosed 42% in men where as only 15% in women. Women were more likely to be diagnosed with HPD (46%).
HPD was correctly diagnosed in 76% female cases and 44% male.
Conclusion: Psychologists were biased in diagnosis by stereotypical views of gender. Such as women were more likely to be diagnosed with HPD (excessive emotion, attention seeking, inappropriate seductiveness).
Method: Self-report
Participants: 354 clinical psychologists, randomly selected from the national register in 1983.
Procedure: Participants were given one of 9 case studies, patients with Anti-social Personality Disorder, Histrionic Personality Disorder, or a mixture of both.
They diagnosed each case study on a 7 point likert scale according to the disorder. (E.g. Narcissistic, anti-social, alcohol abuse).
Findings: ASPD was correctly diagnosed 42% in men where as only 15% in women. Women were more likely to be diagnosed with HPD (46%).
HPD was correctly diagnosed in 76% female cases and 44% male.
Conclusion: Psychologists were biased in diagnosis by stereotypical views of gender. Such as women were more likely to be diagnosed with HPD (excessive emotion, attention seeking, inappropriate seductiveness).
Monday, 1 February 2016
Definitions Of/Defining Dysfunctional Behaviour
Before the publication of the DSM there were a wide range of methods of categorisation of mental health all of which were equally fraught with problems. Rosenhan and Seligman identified 4 types of definition: Statistical infrequency, deviation from social norms, failure to function adequately and deviation from ideal health.
1) Statistical infrequency
In this definition of abnormality, behaviours which are seen as statistically rare, are said to be abnormal. For instance one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal. However, this definition obviously has limitations, it fails to recognise the desirability of the particular behaviour.
Going back to the example, someone who has an IQ level above the normal average would be regarded for their intelligence. This definition also implies that the presence of abnormal behaviour in people should be rare or statistically unusual, which is not the case. Instead, any specific abnormal behaviour may be unusual, but it is not unusual for people to exhibit some form of prolonged abnormal behaviour at some point in their lives.
2) Deviation From Social Norms
Defines the departure or deviation of an individual, from societies unwritten rules. For instance, seeing a man running around the streets naked would be perceived as abnormal. There are also a number of criteria for one to examine before reaching a judgement as to whether someone has deviated from societies norms. First of these criteria are culture: what may be seen as abnormal in one culture maybe seen as normal in another. The second criteria being situation and context: one is placed in, for example; going to the toilet is a normal human act however going in the middle of a supermarket isn't. The third criteria being age: a 3 year old would get away with taking his clothes off in public however a 20 year old wouldn't. The fourth criteria is gender. The fifth criteria is historical context; standards of normal behaviour change in some societies, sometimes very rapidly.
3) The Failure To Function Adequately
When a person is unable to function independently in society.
4) Deviation From Ideal Mental Health
Such as: Lacking positive self view, independence, stress resistance, personal growth capability, accurate view of reality, adaptability to environment
1) Statistical infrequency
In this definition of abnormality, behaviours which are seen as statistically rare, are said to be abnormal. For instance one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal. However, this definition obviously has limitations, it fails to recognise the desirability of the particular behaviour.
Going back to the example, someone who has an IQ level above the normal average would be regarded for their intelligence. This definition also implies that the presence of abnormal behaviour in people should be rare or statistically unusual, which is not the case. Instead, any specific abnormal behaviour may be unusual, but it is not unusual for people to exhibit some form of prolonged abnormal behaviour at some point in their lives.
2) Deviation From Social Norms
Defines the departure or deviation of an individual, from societies unwritten rules. For instance, seeing a man running around the streets naked would be perceived as abnormal. There are also a number of criteria for one to examine before reaching a judgement as to whether someone has deviated from societies norms. First of these criteria are culture: what may be seen as abnormal in one culture maybe seen as normal in another. The second criteria being situation and context: one is placed in, for example; going to the toilet is a normal human act however going in the middle of a supermarket isn't. The third criteria being age: a 3 year old would get away with taking his clothes off in public however a 20 year old wouldn't. The fourth criteria is gender. The fifth criteria is historical context; standards of normal behaviour change in some societies, sometimes very rapidly.
3) The Failure To Function Adequately
When a person is unable to function independently in society.
- Dysfunctional behaviours (OCD)
- Distressing behaviours (Agoraphobia)
- Unpredictable behaviour (Mood swings
- Irrational behaviour (Paranoia)
4) Deviation From Ideal Mental Health
Such as: Lacking positive self view, independence, stress resistance, personal growth capability, accurate view of reality, adaptability to environment
Subscribe to:
Comments (Atom)