Evaluate ways to improve adherence
Compare child-focused and individual strategies with Yokley and Glenwick’s community intervention study, while evaluating sample, outcome and ethical limits.
Section OPTION-HE-3.2.3 · 3.2.3 Improving adherence
Original StudyForA teaching mapped to Cambridge 9990 Health Psychology sections 3.2.1–3.2.3, 2028–2030 Version 1. Example and key studies are not official Cambridge materials or mark schemes. These lessons explain research; they do not advise anyone to start, stop or change treatment.
Before you begin
- This lesson covers Cambridge Psychology 9990 Health Psychology section 3.2.3. It evaluates research interventions and is not individual treatment advice.
Work on paper. Try each question before revealing help, and explain why your method works.
Quick readiness check
Which conclusion best fits the Yokley and Glenwick study?
What you will learn
- Improving adherence in children; Chaney et al. (2004)
- Individual behavioural techniques: contracts, prompts, customising treatment
- Community interventions; Yokley and Glenwick (1984)
Match support to the barrier and involve the person
A contract can set out a jointly agreed behaviour, a realistic record and feedback; a prompt can cue a planned action; and customised treatment can address a person's practical needs or preferences. The technique should fit the barrier. A reminder may help with forgetting, but it cannot by itself remove cost, unclear instructions, side effects or lack of access.
For a child, an adult may help organise treatment, but the child's understanding, comfort and assent should be considered in a way suited to age and capacity. Researchers and practitioners need appropriate consent, privacy and safeguarding. Incentives should be considered carefully; they must not pressure a child or replace an informed conversation with the family and qualified care team.
Customising treatment means communicating with the responsible practitioner about practical fit, not changing a prescribed medicine independently. In research, specify what was changed and measure the target behaviour directly. Improved satisfaction, reported ease, technique, attendance and medication-taking are different outcomes.
Chaney et al. tested a child-friendly spacer in a short pilot
Chaney et al. (2004) recruited 32 preschool children aged 1.5–6 years from seven clinics in Perth. Caregivers completed matched questionnaires before and after two weeks using the Funhaler spacer, and researchers made one random call about whether a child had been medicated the previous day. The paper compared acceptance, ease of use and reported medication behaviour with the families' existing spacer experience.
Among the 30 families with the reported comparison, caregivers said medication was always successful for 22 of 30 children with the Funhaler, compared with 3 of 30 using the existing spacer. The authors also reported improved adherence to frequency and delivery technique, child willingness and caregiver attitudes. These were short-term pilot findings with a small child sample and substantial caregiver report; they do not establish long-term clinical benefit or prove the device works for every child.
The study illustrates customising a device and making a routine more engaging. A larger, longer comparison with clearly defined objective and patient-centred outcomes would help test durability and generalisation. The design does not justify telling a family to choose or use a medical device without advice from their qualified care team.
Yokley and Glenwick tested community prompts and access
Yokley and Glenwick (1984) randomly assigned families of 1,133 under-immunised preschool children in one public-health setting to six conditions: a general prompt, a client-specific prompt, a specific prompt plus increased clinic access, a specific prompt plus monetary incentives, a contact control, or no contact control. The outcome was obtaining immunisations, including clinic attendance, rather than taking a prescribed medicine at home.
Compared with control groups, all interventions except the general prompt showed some evidence of improvement. The monetary-incentive group had the largest effect, followed by increased access, the specific prompt and the general prompt. The authors described the client-specific prompt alone as the most cost-effective. This suggests that identifying a family and reducing practical access barriers may matter more than a generic reminder alone in that setting.
Random assignment supports comparison within the study, but one public-health setting, a preschool immunisation outcome and a historical service context limit generalisation. The work measures community attendance, not long-term adherence to medication or health outcomes. The intervention also raises questions about consent, fairness, privacy and whether an incentive is appropriate in a different community.
Evaluate the target, method and outcome separately
A prompt, an engaging tool and extended clinic hours act on different possible barriers. A fair evaluation first defines the intended behaviour, then checks whether the strategy changed it. Questionnaires can capture acceptability and experience; attendance records or suitable objective traces can describe behaviour; neither should be substituted for a clinical outcome without evidence.
Experiments can support causal comparisons when allocation, measurement and follow-up are sound. But short pilots, caregiver reports, one clinic and small or context-specific samples restrict conclusions. Report who was invited, who participated, what was measured, how long follow-up lasted and whether any participants were missing from the final analysis.
A useful everyday application begins by asking what makes the plan hard to follow. It combines practical support with respectful choice, and checks whether the change helped the defined behaviour without adding unacceptable burden. One successful strategy in one study is not a universal intervention.
Sources for this lesson
- Cambridge International AS & A Level Psychology 9990 syllabus, 2028–2030
- Cambridge International AS & A Level Psychology 9990 Reference List, 2028–2030
- Chaney et al. (2004), A new asthma spacer device to improve compliance in children: a pilot study
- Yokley and Glenwick (1984), Increasing the immunization of preschool children: an evaluation of applied community interventions
Pause and explain
A child-friendly spacer pilot reported improved caregiver-rated success after two weeks. What is the strongest limitation?
Worked example
A health service plans to send every family the same generic reminder and expects attendance to rise. Evaluate the plan using Yokley and Glenwick.
Show the worked solution
- Describe the six-condition random allocation and the 1,133 preschool-child families in one public-health setting.
- Report that the generic prompt did not show the same evidence of improvement as the other interventions; a client-specific prompt was described as most cost-effective.
- Explain why one historical immunisation setting cannot guarantee effects for another clinic or medication behaviour.
Answer Yokley and Glenwick compared several community interventions in one public-health setting. All but the generic prompt showed some evidence of improvement; the client-specific reminder alone appeared most cost-effective. That evidence suggests tailoring may matter, but it does not guarantee that a generic message always fails or that the result transfers to another population, appointment system or medication routine.
Try a topic test
Choose Easy, Normal or Difficult. Save your answers and open worked review after finishing.
Test this topic →From guided practice to a new situation
Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.
A service wants to use Yokley and Glenwick to justify extending clinic hours. Summarise the relevant evidence and one limitation.
Give me a hint
State the group, intervention comparison, outcome and context.
Compare my reasoning
- Families of 1,133 under-immunised preschool children were randomly assigned to six conditions in one public-health setting.
- Increased access was one intervention; the study assessed immunisation-related attendance and found some evidence of improvement relative to controls.
- One clinic and a preschool immunisation outcome limit transfer to another service or to medication-taking behaviour.
The study compared a specific prompt plus greater clinic access with other conditions in one public-health setting and found some evidence of improvement in immunisation-related outcomes. It provides a reason to test whether access matters in this service, not proof that extending hours will work everywhere. The new service should define and evaluate its own attendance outcome.
Look for these in your work
- Sample and setting named
- Relevant result stated cautiously
- Transfer limitation included
A caregiver questionnaire shows a child's acceptance of a new device improved, but clinic records show no change in attendance. Explain why both results can be true.
Give me a hint
Separate attitude or acceptability from attendance and identify how the intervention was expected to work.
Compare my reasoning
- The questionnaire measures a caregiver-reported perception of the child's acceptance of the device.
- Clinic records measure attendance; they do not directly measure device acceptance or medication technique.
- A change in acceptability may not remove appointment barriers, and the two outcomes should be reported separately.
The device may be more acceptable while a separate access problem still affects attendance. The questionnaire and clinic record measure different outcomes, so neither cancels the other. A valid evaluation reports both and tests the proposed pathway rather than assuming that improved attitude automatically changes attendance or health.
Look for these in your work
- Constructs kept distinct
- Possible mechanism explained
- No unsupported causal claim
Propose a fair evaluation of a jointly agreed reminder strategy for follow-up appointments, including child protections if children participate.
Give me a hint
Define attendance, comparison conditions, consent and a respectful way to collect experience data.
Compare my reasoning
- With service and ethics oversight, define the eligible appointments and a fixed follow-up period; compare usual communication with a specific, accessible reminder strategy using suitable allocation.
- Record attendance separately from caregiver or patient ratings, and note cancellations, access factors and missing records.
- Obtain appropriate caregiver consent and child assent, protect contact details, avoid coercive incentives, and report the setting and limits on generalisation.
The evaluation should define attendance in advance, compare a reminder with usual communication under suitable oversight, and measure experience separately. Include access barriers and missing data so a reminder is not credited for changes it did not cause. Obtain caregiver consent and age-appropriate child assent, protect contact information, and avoid pressure or punitive incentives.
Look for these in your work
- Outcome and comparison defined
- Measures and missing data addressed
- Consent, assent and privacy included
Common mistakes
- Treating increased satisfaction as proof of improved long-term health
- Reporting the Funhaler pilot as a large or long-term clinical trial
- Describing clinic immunisation attendance as medication-taking adherence
- Assuming a reminder addresses every psychological or practical barrier
- Using a contract or incentive coercively, especially with children
- Recommending that a learner or family change prescribed treatment independently
What can you explain now?
What was the key outcome in Yokley and Glenwick's community study, and what does it not establish?
Compare with the explanation
The study examined immunisation-related clinic attendance among families of under-immunised preschool children; it did not test long-term adherence to prescribed medicines or health outcomes across settings.
Keep the behaviour measured separate from the broader claim you want to make.
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Make it stick
Compare one individual and one community strategy for improving adherence, then state the target behaviour and main limit of each study.
If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.