The trouble with insights

The recognition that non-adherence is multifactorial is vital, with health psychology research demonstrating the importance of understanding an individual's beliefs and circumstances that may be influencing non-adherence. Patient support programmes that seek to address non-adherence can often focus on generic 'insights' that band patients together into fixed segments and provide a one-size-fits-all intervention. These often fail to incentivise comprehensive and long-term behaviour change as their ability to address individual needs is limited.

Sustainable behaviour change requires an understanding about what it is that drives behaviour. Atlantis Healthcare has applied the established behaviour change model COM-B (how Capability, Motivation and Opportunity impact on Behaviour) to address the problem of non-adherence. With this model, Atlantis Healthcare identifies the beliefs, external influences and abilities of each individual patient, and how these combine to influence adherence behaviours. Addressing these individual factors in the form of effective, evidence-based interventions ultimately improves treatment adherence in the long term.

Sustainable behaviour change requires an understanding about what it is that drives behaviour

The need for permanent behaviour change
Treatment non-adherence rates are high among those with chronic diseases, with 50% of patients not adhering to their prescribed treatment. This is because living with a chronic disease often requires varying degrees of self-management on behalf of the patient, of which treatment adherence forms a key part.

Adherence programmes should consider all the key factors that can predict non-adherence. In this respect, patients' perceptions about their illness and the beliefs they hold in relation to their treatment are the most consistent influencers. These beliefs include:
Doubts about the need for treatment

• Concerns about potential side effects
  
• Consequences of the illness versus the burden of treatment
  
• The extent of control individuals feel over their disease
  
• Their experience of symptoms 
  
• Their understanding of the nature and time frame of the condition.
  
• ability can influence both behaviours and beliefs.External influences, such as level of social support, healthcare professional relationships and level of understanding and ability can influence both behaviours and beliefs.
  

The COM-B model
Applying evidence-based research strategies to the problem of non-adherence provides a robust basis for identifying behavioural barriers and facilitators. One example of this is the COM-B model, which Atlantis Healthcare applies to help understand a patient's belief system, ability and external influences that can all potentially have an impact on an individual's adherence behaviours. Evidence based behaviour change techniques are then identified and mapped to their relevant behavioural factors. Where appropriate, technology solutions and user experience design principles are also incorporated into solution design to ensure interventions are delivered in a personalised and effective way.

Addressing individual factors ultimately improves treatment adherence

The COM-B model in action
Atlantis Healthcare has conducted a number of programmes where validated predictors of non-adherence are used. In a recent patient support programme, adherence in inflammatory bowel disease patients who participated was significantly higher, with the majority of patients saying that they'd benefited from it. The programme was personalised on individual beliefs with content delivered through a multichannel solution, including web and SMS targeting these specific beliefs as well as providing solutions to address broader self-management outcomes.

Designing a unique adherence programme with personalised interventions helps patients better self-manage their condition. By addressing the deep rooted beliefs of individuals and providing support to improve capability and enhance opportunities, long-term behaviour change is achieved. This is because we are supporting the individual to be an active partner in making their own changes.

Clare Moloney, director of clinical strategy at Atlantis Healthcare