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Book aims to improve patients' adherence to doctors' instructions

By Ann Friou
University News Service
February 19, 2010

Health Behavior Change and Treatment Adherence

If you don’t always follow your doctor’s recommendations, you’re not alone.

Every year, millions of people resolve to adopt a better diet, exercise more, or lose weight, but doctors know the likelihood is low that patients will develop new health behaviors and maintain them. In fact, studies show that between 25 and 50 percent of patients don’t follow their doctors’ recommendations.

Pointing out that doctors get little training in medical school for changing patient behavior, a national team of research psychologists has published a book giving healthcare professionals effective strategies for helping their patients improve their health behaviors and adhere to treatment.

The book, Health Behavior Change and Treatment Adherence: Evidence-Based Guidelines for Improving Healthcare (Oxford University Press 2009), is coauthored by Kelly B. Haskard-Zolnierek, assistant professor of psychology at Texas State University-San Marcos; M. Robin DiMatteo, distinguished professor of psychology at the University of California-Riverside; and Leslie R. Martin, professor of psychology at La Sierra University in Riverside, Calif.

Drawing on 50 years of empirical research, the authors show that three ingredients must be present before a patient’s behavior will change: 1) The patient must understand what kind of change is expected; 2) the patient must be motivated to carry out the behavior even when they know what behavior is expected, and 3) they must have the tools they needs to change their behavior.

Factors such as access to medical care and insurance certainly affect the patient’s ability to adhere to treatment, Haskard-Zolnierek explained, but the quality of communication between the physician and patient is a key determinant of a patient’s understanding of treatment and his motivation to comply.

“If patients are dissatisfied with the physician’s form of communication, for example, they’re less likely to follow through with treatment,” Haskard-Zolnierek said. “On the other hand, when physicians are affective communicators—when they are friendly and empathetic, and when they give clear information without using medical jargon—patients are more likely to be satisfied with their treatment and to adhere to it.”

Recognizing that busy healthcare professionals work on tight schedules, the authors provide simple strategies for helping patients to understand what they need to do, persuading them to change their behavior, and overcoming barriers to change. For example, healthcare professionals might:

• Employ a team approach to providing patient care by giving the patient pre-appointment counseling and help in setting a healthcare agenda
• Provide interactive decision-making aids that help patients get the information they need to make medical choices
• Provide group visits for patients with the same chronic illness
• Provide technology-based adherence aids such as reminders via cell phone or email

Drawing on thousands of empirical studies, the authors also offer guidelines on topics such as improving health through the development and management of habits, helping patients to evaluate risks and make decisions, effective collaboration with patients, and creating partnerships between patients and the healthcare system.

“Healthcare practitioners of all kinds should find this book useful,” said Haskard-Zolnierek, pointing out that it was written for professionals and students in fields such as medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology and care administration.

“The book is also for laypeople who want to take an active role in their own health,” Haskard-Zolnierek said.

She added that she hopes the book will encourage healthcare professionals to discuss regularly with their patients the value of adherence to treatment and of changing unhealthy behaviors.

“The topics discussed in this book are timely, considering the recent call for healthcare reform,” she said. “Changing health behaviors may reduce the risk of some chronic diseases, decreasing the accompanying financial burden. Following through with recommended treatments can also reduce healthcare waste.”

Health Behavior Change and Treatment Adherence is available from Oxford University Press ( and online bookstores.