Kulik and Carlino(1987) carried out an experiment in which they tested a method of increasing adherence. Parents in the experimental group were simply asked by the physician, "will you promise me you'll give all the doses?" and all agreed; parents in the control condition were not asked for commitment. There was a follow up visit 10 days later. Significantly more children complied as ascertained by urine samples and interviews with parents. Children who promised were more likely to adhere therefore fulfilling their promises.
In 2000 Sherman et. al. performed a quasi experiment in which they checked adherence on asthma medicines-inhalers at patients' pharmacy’s. To achieve the results, patient's pharmacies were telephoned. Adherence was calculated as a percentage of the number of doses refilled divided by the number of doses prescribed. It was over 100 asthmatic children in the USA and pharmacy records were compared with doctor's records, as well as records of the medical insurance claims for treatment. 90% accurate pharmacy information. Adherence rates were found to be quite low (e.g. 61% for inhaled conticosteroids) and doctors were not able to identify patients who had poor adherence. They concluded that the pharmacy information was over 90% accurate and could therefore be used as a basis for estimating medicine used.
The first evaluation issue to be discussed is methods. Methods consist of both experimental (laboratory, field, quasi) and non-experimental (self-report measures, questionnaires, interviews, surveys, case studies and correlations). Qualitative and/or quantitative data may be employed. The study may be cross sectional or longitudinal.
Barat et al. used a semi-structured interview. By using this method Barat et al were able to follow up any interesting and revealing questions that they would need to ask about the medicine taken, which allows a degree of flexibility. This method also makes data easier to quantify, and Barat et al made comparisons between the GP’s and the patient’s answers. However, this method is difficult to replicate, as the patients situation could change over time by the doses that the patient may be taking or the amount of drugs used. In contrast, For this study, Sherman et al. used a quasi-experiment. This is an advantageous method as it reduces the tendency for demand characteristics. This study would not be able to be replicated as the sample would produce dissimilar results and the situation would be different. There is little control over variables therefore cause and effect cannot be established with certainty. The doses of the individual patients with differ dependent upon their condition too. Chung and Naya as well as Kulik and Carlino both, on the other hand chose to carry out field experiments. By choosing a field experiment Chung and Naya were able to study behaviour that would not have been able to have been studied in a laboratory. However the experimenters could not have tight control over variables as they were not present in the home of the patient when they were taking medication. Kulik and Carlino were able to study the behaviour/adherence of the children in their own environments. By conducting a field experiment there is a reduction in demand characteristics. There is however little control over the variables and by asking the children to give urine samples, there is the possibility of it being stressful for them.
Another evaluation issue to be discussed is ecological validity. Ecological Validity refers to how well a study can be related to everyday life. By conducting a quasi experiment, Sherman et al had increased ecological validity- more so than the laboratory experiments. This study is high in ecological validity due to the experimental method used. There was no need for experimentation/pretence. There are no forced situations. Phone calls were made, then calculations, and many records were investigated. It is true to everyday life in the sense that it is nothing out of the ordinary that the patients are doing or that the experimenters needed to do. Another study that was relatively high in ecological validity was that of Kulik and Carlino. It was true to everyday life in that patients attending a surgery as normal, however to have to give urine samples to monitor adherence, it is not very true to everyday life. To have to promise to take or give medicine is also quite an uncommon thing to do. Similar to Kulik and Carlino’s study, Chung and Naya made use of a field experiment. This study was not especially high in ecological validity because The ecological validity is not particularly high because it is not everyday occurrence to have your adherence to medical advice measured. The TrackCap is not used frequently and usually there is no way to check how many tablets the patient is taking. Barat et al used semi structured interviews to carry out their experiment. This experiment is the least ecologically valid as there is a higher degree of abnormality; the situation is not common, as it is not usual for someone to ask questions on the medicine taken or to look through the medicine cupboard. By asking the GP questions is not common either, as doctors adhere to their own set of ethics which can not be breached, as information on patients is usually kept confidential.
The third evaluation issue to be discussed is ethics. Ethics are a set of rules designed by the APS (American Psychological Association) and BPS (British Psychological Society) to distinguish between right and wrong. The study by Barat et al was an ethical study. The study is ethical as the guidelines were not breached. The patients and GP consented to being asked questions and for their medicine cupboard to be searched. Confidentiality was kept as no names were released from the study. The patients were protected as they were not harmed mentally or physically. The participants were not deceived so there was no need to debrief participants. The participants were able to withdraw as they did not have to answer the questions asked by the experimenters. Chung and Naya were also very aware of the ethical issues and therefore complied well. The participants did give consent, and although they did not know all the details of the TrackCap they were informed that their adherence was going to be measured. There was no distress, as the participants were simply following an everyday routine, and had agreed to have their adherence measured so there was no invasion of privacy. Confidentiality was also maintained. Similar to Chung and Naya, the Kulik and Carlino study was quite ethical in many ways, however the children having to give urine samples might have been slightly distressing for them. It was a paediatric setting also, therefore there would have been no real reason to decline, other than principle. Again, the Sherman study was fairly high in terms of ethics. Participants' information was used only for experimental purposes so they would not have been deceived or taken advantage of/harmed in any way. Consent was given as the documents used would usually have been confidential, therefore confidentiality was also maintained.
Usefulness of research refers to the contribution that psychology makes to human welfare. The study by Kulik and Carlino appears to be useful as there is notification of adherence increasing with the person stating explicitly that they are complying. The study showed that with higher compliance rates came greater recovery from their illnesses. The Barat et al study is useful as it shows that doctors need to release more information to their patients concerning information about the medicine their patients are taking; such as why they are taking the medicine and what it is for. This could therefore make people adhere to taking their medicine. If these problems are recognised, things can be done to improve patient adherence, and hopefully recovery rates. The studies by Chung and Naya, and Sherman, were not as useful. They both successfully measured adherence rates, but do not show any way in which these could be improved. The field experiment by Chung and Naya does not show why some patients adhere more than others, or how adherence may be improved in the patients who did not take the drug as often as they should have. Sherman’s study also lacked usefulness as it did not show anything which had not been shown in any study previously carried out. It was also only carried out on a small scale, and therefore the study cannot be generalised across a wider population.
Getting children to take medication with the aid of their parents is difficult enough, but making them take their medicine without persuasion or help is even harder. One such medication is an asthma inhaler. Psychologists have found out that patients tend to adhere to medical advice when there is an incentive which has been pointed out to them. The study by Barat et al. shows that patients are much more likely to adhere to a treatment if they know more about the treatment. To make the child’s adherence to the medical subscription better then a reward scheme (positive reinforcement) could be introduced, for example for every week/month the child has a perfect dosage score then they will receive a bag of sweets.
The doses could be measured using an electronically device similar to the ‘TrackCap’ used by Chung and Naya (2000) in heir experiment. Each time the child goes to the doctor the child gives him his inhaler and the doctor checks to see if the number of uses and refills fit’s the time period, if so the child would get a reward. With the incentive of the sweets the child would become more eager to get a perfect score and get his sweets, the positive reinforcement therefore causing the child to adhere to the prescription far better.
