Implies a passive role, following demands of prescriber.

Non-compliers seen as deviants, incompetent, unable to follow instructions.

Implies an active role, in collaboration.

Self-motivated decision to adhere to treatment advice.

Self-regulation of treatment.

Adherence vs. Compliance?

What are evidence-based approaches?

- Strategies should be used because there is evidence to support them!

Evidence says no.

Might work short-term, but doesn't last

Evidence says we can change cognition and affect.

Adherence Strategy: Explore client's motives, values, barriers

Remember: ABC

Affect

Behavior

Cognition

The Role of Motivation:

Deci & Ryan's Psychological Needs Approach

Remember: CAR

 Competence

Autonomy

Relatedness

1. Give positive feedback (competence)

2. Promote moderately difficult goals (competence)

3. Promote self-referenced goals (autonomy)

4. Provide a choice of activities (autonomy)

5. Provide a rationale for activities (autonomy)

6. Promote development of social networks (relatedness)

How do people change?:

- Self-Efficacy

- Decisional Balance

Stages of Change:

Precontemplation

Contemplation

Preparation

Action

Maintenance

When you feel confident.

"The confidence that you can be active, particularly in challenging situations."

The pros and cons of change.

Pros:

- I would be healthier if I exercised

- Other people would respect me more if I exercised.

Cons:

- It is expensive to join a health club

- I would probably be sore and uncomfortable if I exercised.

Don't exercise, no intention of starting.

"So far as I'm concerned I don't have any problems that need changing."

"I guess I have my faults but there is nothing I need to change."

"I don't go along with all this health promotion crap - life's too short! You've got to die from something!"

Don't exercise, thinking about starting, some sort of commitment to change in the near future.

"Yes I know I have a problem, but I'm not ready to do anything yet!"

"Just wait until I get these class papers done, then I'll start my new regime."

"I'm just too stressed at the moment to even think about exercising."

Don't exercise, but making small changes. May set imminent date on which change is to take place (usually within a month). Psychologically prepared for change.

"Ok, I've joined the gym. I'll start on Monday."

"I've signed up for aerobics, there's no backing out now."

"This is the last weekend before I start my fitness program."

Started exercising regularly, but only recently. Meeting criterion for physical activity.

"Anyone can talk about exercising... but I'm actually doing it!"

"It's not easy but I'm giving it my best shot!"

"I don't get out of breath anymore by taking the stairs!"

Been exercising regularly for 6 months. Work to prevent relapse. Relapsing between these stages occasionally is not unusual.

"I'm an exerciser."

"It was easy at first but there are times when I can't face getting out of bed to go running before work."

"Just think... a whole two days with no exercise... heaven!"

Can apply to everybody

- Stage-matched interventions

Helps understand the real problem

- Distribution of population by stage

- Helps us answer "how are we doing?"

Recruitment and retention by stage

- Need to go after precontemplators

Progression by stage

- Progress related to stage at enrollment Rate of progression by stage

- Early stages take longer

Theoretical models that have tried to understand behavior change:

Fear Appeals

Education-based

Motivation-based

Empirically based (developed from self-changers)

- Stages of Change

- What? Why? How do people change?

- Stage matched strategies