title: Medication adherence as a learning process: insights from cognitive psychology.
abstract: Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.
authors.affiliation: a Department of Psychology , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Benjamin Margolin
authors.initials: BM
authors.lastname: Rottman
authors.affiliation: b Department of Pharmacy , University of Washington , Seattle , WA , USA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: c Department of Pharmacy and Therapeutics , University of Pittsburgh School of Pharmacy, VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.affiliation: d Division of General Medicine and Center for Pharmaceutical Policy and Prescribing , University of Pittsburgh, VA Pittsburgh Healthcare System , Pittsburgh , PA , USA.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007858:Learning; D055118:Medication Adherence; D008960:Models, Psychological; D018802:Patient-Centered Care; D057285:Precision Medicine / Q000523:psychology; D012648:Self Care / Q000523:psychology
keywords: Adherence; causal learning; self-management; value–expectancy