title: Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video.
abstract: OBJECTIVE
  Patient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social-cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients.
  
  
  METHODS
  Forty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews.
  
  
  RESULTS
  Self-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization.
  
  
  CONCLUSIONS
  Adherence may be predicted and influenced via social-cognitive means. Mobile technology can extend therapy to extraclinical settings.
authors.forename: Eva
authors.initials: E
authors.lastname: van Leer
authors.forename: Nadine P
authors.initials: NP
authors.lastname: Connor
mesh_terms: D000328:Adult; D005260:Female; D006040:Goals; D006801:Humans; D007100:Imitative Behavior; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000628:therapy*; D055539:MP3-Player; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D011369:Professional-Patient Relations; D011446:Prospective Studies; D012648:Self Care / Q000523:psychology; D020377:Self Efficacy; D012984:Software; D016896:Treatment Outcome; D014741:Video Recording; D014832:Voice Disorders / Q000175:diagnosis / Q000628:therapy*; D014834:Voice Training; D055815:Young Adult