Explain why patients may not follow medical advice
Distinguish types of non-adherence, apply the Health Belief Model, and evaluate Laba et al.’s evidence about treatment trade-offs.
Section Paper 4 · Specialist Options: Application and Research Methods
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 3.2.1. Examples are for evaluating psychological explanations, not personal medical decisions.
Work on paper. Try each question before revealing help, and explain why your method works.
Quick readiness check
Which conclusion is supported by Laba et al. (2012)?
What you will learn
- Failure to follow treatment and failure to attend appointments, and resulting problems
- Rational non-adherence; Laba et al. (2012)
- Health Belief Model explanation
Define the behaviour before explaining it
Adherence describes how far a person's behaviour follows an agreed treatment plan or medical advice. Non-adherence can include not starting or following treatment as planned, or not attending an appointment. The exact behaviour, plan and time period need to be stated; one missed dose and a long-term pattern are not the same outcome.
Non-adherence can be intentional, such as deciding that a treatment's likely harms or burden outweigh its expected benefit, or unintentional, such as forgetting, misunderstanding instructions, being unable to get a prescription, or finding a schedule difficult to manage. These categories can overlap and may change over time. They describe possible processes, not a judgement about a person's character.
If a treatment is not followed as planned, its intended benefit may not be realised, a condition may remain uncontrolled, and a clinician may misread the response as treatment failure. Missed appointments can also delay review. These are possible problems, not inevitable outcomes: effects depend on the treatment, condition and circumstances. Only a qualified practitioner can interpret an individual case.
Rational non-adherence treats a choice as a trade-off
A person may weigh expected benefit against side effects, immediate or long-term harms, cost, the effort or timing of a regimen, restrictions and their experience of the condition. A choice can be understandable from that person's information and priorities even when it conflicts with a practitioner's advice. Calling it rational describes a decision process; it does not mean the choice is medically safe or informed.
Laba, Brien and Jan (2012) used an online discrete-choice experiment with 161 Australian community participants recruited through a panel; the participation rate was 10%. Participants chose between hypothetical medication profiles. Six of eight factors significantly influenced preferences to continue: immediate and long-term harms and benefits, cost and regimen. This was stated preference about hypothetical, non-disease-specific medicines, not observation of actual prescriptions being taken.
The experiment standardised hypothetical choices so researchers could compare the relative influence of attributes. It cannot show how many people would actually stop a medicine, what any participant's clinician advised, or whether a choice was medically appropriate. The low participation rate and an Australian sample also limit generalisation. The finding supports considering patient priorities; it does not prove one explanation fits every individual.
Use the Health Belief Model as one organising framework
The Health Belief Model proposes that health action can relate to perceived susceptibility (could this affect me?), perceived severity (how serious might it be?), perceived benefits (would the recommended action help?), and perceived barriers (what makes it difficult?). A cue to action may prompt a decision, while self-efficacy concerns confidence in being able to carry it out.
For example, a person who sees little personal risk, doubts a treatment's benefit, worries about side effects and faces a difficult schedule may be less likely to follow a plan. A reminder can act as a cue, but it will not necessarily remove concerns or access barriers. The model helps organise questions; it does not establish which belief caused one person's behaviour.
The model can be criticised as an individual-level account: it may understate costs, transport, service availability, family responsibilities, culture and treatment design. Beliefs can also be difficult to measure and may be reconstructed after a decision. Combine the model with the person's own account and the situation rather than treating one questionnaire score as a full explanation.
Sources for this lesson
Pause and explain
Which is the best first step when explaining one missed appointment in a case vignette?
Worked example
A study group says a patient who misses an appointment is simply careless. Explain why that claim is too narrow.
Show the worked solution
- Define the observed behaviour and avoid inferring a motive from one missed visit.
- Separate intentional decisions from practical or memory barriers, noting that causes can overlap.
- Apply one Health Belief Model construct and one situational factor, then state what evidence would be needed.
Answer One missed appointment does not reveal the person's reason. A perceived barrier may be practical, such as transport or timing; a belief about risk or benefit may also matter. The Health Belief Model can organise questions, but a respectful conversation and relevant context are needed before explaining an individual case. A general model cannot establish motive from the behaviour alone.
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 participant in a hypothetical survey prefers a medicine with fewer side effects but a more demanding schedule. Use Laba et al. carefully.
Give me a hint
Identify the stated preference and distinguish the experiment from actual adherence.
Compare my reasoning
- The study varied attributes of hypothetical medicines and asked participants to choose between profiles.
- Harms and regimen were among the factors that significantly influenced stated preferences in the sample.
- The result concerns a hypothetical choice, so it does not show what the participant would actually take or what a clinician advised.
The preference illustrates a trade-off between treatment attributes. Laba et al.'s experiment found that harms and regimen influenced stated preferences, but participants chose among hypothetical profiles. The result does not establish actual adherence, medical appropriateness or an individual cause.
Look for these in your work
- Study method identified
- Relevant factors applied
- Limits on actual behaviour stated
A case says a person believes a preventive treatment is unnecessary, worries about side effects and has difficulty reaching the clinic. Apply the Health Belief Model and evaluate the explanation.
Give me a hint
Map beliefs to model constructs, then include a situational access factor and one limitation.
Compare my reasoning
- Low perceived susceptibility or low perceived benefit may reduce motivation to act.
- Concern about harms can be a perceived barrier; difficulty reaching the clinic is a practical situational barrier.
- The model organises beliefs but does not prove their causal role or remove the need to consider access and the person's own account.
The case includes possible low perceived susceptibility or benefit and a perceived barrier related to side effects. Clinic access is a situational barrier that an individual-belief model may understate. These concepts help frame questions but do not prove which factor caused the behaviour; the case needs more evidence and context.
Look for these in your work
- At least two model constructs used
- Belief and situation distinguished
- Causal limit stated
Design a short follow-up study to distinguish a stated reason for missing a clinic visit from the circumstances that prevented attendance.
Give me a hint
Combine the person's perspective with a clearly defined behavioural outcome, and protect privacy.
Compare my reasoning
- Use a respectful semi-structured interview to ask what the person expected, believed and experienced without leading them.
- With appropriate consent, compare the account with appointment records and record relevant access factors such as timing or transport separately.
- Report who took part and who did not, distinguish explanation from association, and avoid treating one person's account as universal.
A semi-structured interview can capture an individual account, while appointment records define attendance and access questions capture situational factors. With consent and suitable privacy safeguards, the measures can be compared without assuming that one caused the other. Non-response, recall and a small sample limit generalisation.
Look for these in your work
- Subjective and behavioural evidence separated
- Ethical consent and privacy included
- Sampling and causal limits stated
Common mistakes
- Treating non-adherence as a stable personality trait or moral failing
- Assuming a rational choice is medically safe or based on complete information
- Reporting Laba et al.'s hypothetical preferences as observed medication-taking behaviour
- Claiming that the Health Belief Model proves why one person acted
- Ignoring practical, social and service-level barriers
- Assuming every missed appointment or dose has the same consequence
What can you explain now?
What did Laba et al. measure, and what could their discrete-choice experiment not establish?
Compare with the explanation
They measured preferences among hypothetical medication profiles in an online community sample; they did not observe actual adherence or establish a reason for any individual's behaviour.
A stated preference is data about a hypothetical choice, not direct evidence of what someone did.
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Make it stick
Define non-adherence, explain one rational trade-off, and distinguish a Health Belief Model construct from a practical access barrier.
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.