Middle Range Nursing Theory: Medication Adherence Model

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Table of Contents

Introduction
Scope
Context
Content
Theory Evaluation
Reference List

Introduction

This paper provides an analysis of the theory on medical non-adherence by Jonathan. This paper looks at the theory in terms of its scope, the context within which it developed the content of the theory, the significance of the theory, internal consistency within the theory, the testability of the theory and the pragmatic test of the theory. In essence, this paper looks into the key tenets of the theory in terms of relevancy and general applicability.

Scope

The medical adherence theory was constructed to provide a description of patterns related to treatment adherence in patients. This theory is concerned with the obstacles to medication adherence as well as its scope in terms of the population groups mostly affected by the non-adherence behavior. Besides this, the theory also provides the available solutions to the health workers dealing with patients who fail to adhere to medication instructions. Lack of adherence to medication in patients can at times be intentional – a decision made by the patient not to adhere to medication, or unintentional – interruptions beyond the patient’s control. In summary, therefore, the medication adherence theory , “defines the problem of medication adherence, provides information on the available measuring instruments and predictors of medication adherence, reviews specialized problems with medication adherence in minorities, adolescents and the mentally ill, and provides practical solutions for the health workers dealing with this challenge” (Johnson, 2002).

Context

The development of the medication adherence theory was steered by the increasing number of non-adherence cases in patients especially those suffering from chronic illnesses such as HIV/AIDS and hypertension. Statistics indicate that half of the patients who have been put on medication have problems adhering to the prescriptions either intentionally or unintentionally. This amounts to millions of dollars being spent annually on complicated cases, which could have been avoided. Besides the financial loss, non-adherence to medication has also resulted to reduced lifespan and poor quality of life.

This is what compelled the health analysts to develop this theory, which is aimed at reducing the number of premature deaths caused by ignorance towards medication, and to improve on the quality of life of patients living with chronic diseases (Johnson, 2002). This theory established the main causes of this health threatening behavior, the main one being lack of money to purchase drugs over a long period. This however became controversial when it was discovered that this problem is also common with patients on health plans, which enable then to have access to medication at absolutely no cost.

Content

The three main concepts evaluated in this theory in relation to medical adherence behavior include purposeful achievement, patterned behavior and feedback. Purposeful achievement involves the process whereby patients’ adherence to medication depends on their self-propelled decisions to do so and this is brought about by the effectiveness of the medication, the perceived need and the safety. Patterned behavior follows which is mainly concerned with the patterns developed by the patient with regards to taking medication. This is made possible when the patient has an infinite access to the medication and when they develop the routine in their mind set concerning the process of adhering to medication (McEwen & Willis, 2011). Finally, feedback comes because of the medication response in the health of the patient. When the medication is responding positively, the patient will tend to develop the purposeful achievement and the patterned behavior hence developing a complete medication adherence behavior.

Theory Evaluation

Significance

This theory is of great significance to both the patients and healthcare providers since it endows them with the framework of dealing with non-adherence patterns. The main idea behind this model is to try to influence the decisions made by the patients to forfeit medication, which eventually lands them into more serious health problems than the previous situation. The first step taken in order to reduce the trend of non-adherence to medication among patients is making them believe that they are vulnerable to the diseases. This is aimed at eliminating the notion that they are well immune from all kinds of diseases hence believing that they do not need medication. The second step is to inform them that the disease can be a possible threat to their lives and the third step is to educate them on the benefits that they will accrue from seeking medical help and adhering to the medication prescribed. Finally, they should be informed that the process of obtaining disease intervention is not a complicated one and it can fit into any person’s schedule.

The other significance of this model is that it illustrates health conducts in association with the individual’s psychological depiction of the possible health threats. This element has four main fundamental mechanisms. The first mechanism is identity, which is simply identifying the general symptoms of a disease even when it is considered asymptomatic (Peterson, 2008). The second one is cause whereby people associate different symptoms of diseases with their respective causes and have a pre-determined period over which they expect the disease to last. The last one is consequence evaluation, which involves assessing the cost of the disease, and the benefits accrued from adhering to medication. These are important tools to health care providers in determining the type of medication that should be administered to a patient and the consequences of failing to follow the medication instructions which most of the times leads to the development of resistance towards medication.

Internal Consistency

The medication adherence form is an important tool when determining internal consistency in the medical adherence model. Through this, the continuous variables are converted into discrete numbers, which allow a scale correlation to be conducted. Scores of 0’s or 1’s are attached to the variables and the percentage score is determined. The results of this indicate that most patients fail to adhere to medication intentionally, with lack of access being the least possible reason. The rate of non adherence especially in patients suffering from HIV is high ranging between 29% and 45% and this owing to the fact that this a life time medication (Gustafson et al, 2001).

The internal consistency in this theory can be considered to be an excellent one owing to the congruence between the content and the context of the model. The model is aimed at ascertaining the medication trends in patients, especially those suffering from long term illnesses such as hypertension and HIV/AIDS. The content of the theory and the research conducted shows that medication adherence is a big problem among this population. To come with this conclusion, the sample population was drawn from a group of patients suffering from hypertension. The outcome revealed that most of these people are compelled to take medication by the appearance of symptoms despite the fact that they are aware of their ill health.

Parsimony

The content of this theory has been clearly explained and illustrated with experimental results. This is brought out by the way the facts are stated and explained in a simplified and concise manner that is understandable. The theory has been broken down into other theories that are related to the entire subject such as the “theory of reasoned action, the social learning theory and the self regulation model” (Johnson, 2002). It also explains the factors that contribute to the development of the medical non-adherence trend in patients, and these are the issues affecting people in their daily lives such as financial difficulties. Besides this, the medical non-adherence model suggests possible solutions to this problem.

Research conducted on patients with problems of adhering to medication indicates that most of them have a cost cutting behavior, which compels them to cut on medication costs. Most patients seek medication only when they come across symptoms of diseases and terminate it the moment the symptoms disappear. They consider it a waste of resources treating a disease that is not visible yet they forget that the future cost of dealing with the consequences of non-adherence to medication is far much higher than the former. This is because failing to adhere to the prescribed medicine may bring about other health complications that could have been avoided.

Testability

In testing this theory, the study design used includes quantitative and descriptive correlational methods. When using the descriptive correlational method, non-adherence to medication is described in its natural state of occurrence for the results to represent reliable conclusions from the available information. The research population for testing the viability of this model is sample of patients suffering from hypertension and HIV mainly because these are the most common chronic illness that require a lifetime of medication. Another important aspect to consider when testing this model is the fact that medical adherence is a continuous variable which should be created by obtaining average scores for each respondent in the sample (Peterson, 2008). This study is conducted across both genders in order to determine the gender that is most vulnerable to the unhealthy habit of non-adherence to medication and the reasons behind this distribution.

Empirical Adequacy

This describes the descriptive models that provide support to the assumptions made in relation to medication adherence decision making in patients. One of these assumptions state that most patients who have problems adhering to medication lack social support and adherence self control (Fawcett, 2005). The other one purports that the treatment procedure of most of the chronic illnesses is a complex one. Research conducted based on empirical adequacy suggests a strong relationship between medical adherence and the patient’s characteristics such as race, age and socio – economic factors alongside psychological factors such as depression, drug abuse trends and the satisfaction obtained from the services offered by the health providers.

Pragmatic Adequacy

This describes the prescriptive models, which facilitate successful decision making in normative models. The theoretical allegations made in the medication adherence model are consistent with the pragmatic evidence brought out by the research conducted. One example of this is whereby the model illustrates “the effect of social and environmental factors and personal attributes on medication adherence patterns” (Johnson, 2002). The research findings indicate that the living conditions of patients, which is a social factor affects their medical adherence patterns of the patient directly.

Reference List

Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories. 2^nd Ed. Philadelphia: F.A. Davis Company.

Gustafson, D. H., Johnson, P. R., Molfenter, T. D., Patton, T., Shaw, B. R., & Owens, B. H. (2001). Development and Test of a Model to Predict Adherence to a Medical Regimen. The Journal of Pharmacy Technology: Jpt: Official Publication of the Association of Pharmacy Technicians, 17, 198-208.

Johnson, M. J. (2002). Medication Adherence Model: A Guide for Assessing Medication Taking. Research and Theory for nursing Practice. An International Journal, 16.3, 179 – 192.

McEwen, M., & Wills, E. (2011). Theoretical basis for nursing. (3nd ed.). Philadelphia: Lippincott Williams & Wilkins

Peterson, S. J. (2008). Middle Range Theories and Essentials of Nursing Research. Lippincott Williams & Wilkins.

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