Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems.     

Compliance in crisis: Concern,trust and distrustful complacency in the COVID-19 pandemic

Two studies tested a distrustful complacency hypothesis, according to which either concern or political trust would be enough to sustain law-abiding attitudes and compliance with health-protective policies during the COVID-19 pandemic; but the absence of both concern and trust would result in markedly lower support and compliance. Study 1 supported this hypothesis with NatCen nationally representative sample of Great Britain (N = 2413; weighted regression analyses), focussing on law-abiding attitudes. Study 2 (preregistered) replicated these findings with a representative sample (N = 1523) investigating support for COVID-19 policies and compliant behaviour. Participants who were less concerned about the consequences of the pandemic (for themselves and for others) and simultaneously less trustful of the government expressed weaker law-abiding attitudes and reported less compliance with COVID-19 restrictions. These findings have implications for policy and public health strategies in time of crisis.     

MAINTENANCE FACTORS IN COERCIVE MOTHER-CHILD INTERACTIONS: THE COMPLIANCE AND PREDICTABILITY HYPOTHESES

Two stimulus control processes by which some parent-child dyads occasionally escalate their aversive exchanges into progressively more coercive interactions are described. The compliance hypothesis suggests that aversive actions have instructional properties for the dyad and that parent compliance with such child instructions maintains behavior chains of increasing aversiveness. The predictability hypothesis suggests that social interactions are most likely to function as aversive stimuli in the dyad when delivered in unpredictable fashion by either party and that responses instrumental in reducing dyadic unpredictability maintain aversive behavior chains. Expectations derived from both hypotheses are evaluated in a series of correlational analyses of mother-child interactions obtained in extended baseline observations of three dyads seeking psychological help for severe interactional problems. Results provide tentative support for the predictability hypothesis and suggest important avenues of further research.     

Pedestrian compliance and cross walking speed adaptation due to countdown timer installations: A self report study

Although they are aware of the possible risk, a high number of pedestrians still violate the red light indication and cross the road illegally. This hazardous behaviour may cause incidents between them and the road vehicles. In order to reduce this illegal behaviour, the traffic signals are equipped with countdown timers, in order to provide more information and decrease pedestrians’ noncompliant behaviour. The main purpose of the present paper is to investigate the influence of countdown timers on pedestrians’ compliance regarding their crossing behaviour at intersections as well as to examine the parameters affecting walking speed adaptation. In the context of this analysis two regression models were developed. The first model is a binary logistic regression model which examines pedestrians’ self reported compliance. The results showed that the gender, the age, the perceived comfort and the seconds remaining for the onset of red light are the main parameters that affect compliance. The second model is an ordinal regression model which examines the factors that make pedestrians adapt their walking speed as they are crossing the road and are informed by the countdown timers about the second remaining for the termination of the green phase. The results of the second model revealed that the age, the compliance and the perceived assistance that the countdown timer provides for the walking speed adaptation affect the minimum remaining time before a pedestrian accelerates.     

THE EFFECT OF A TOKEN ECONOMY ON DIETARY COMPLIANCE FOR CHILDREN ON HEMODIALYSIS

Adherence to dietary restrictions is a recurring problem for children on hemodialysis. The effect of behavior modification in maintaining dietary control is reported for four patients aged 11 to 18 years. Weight gain, potassium level, and blood urea nitrogen were utilized as criteria measures. A token reinforcement program implemented by the hemodialysis team resulted in significant changes in the dietary pattern of the children. The average weight gain between dialysis sessions for the four subjects during treatment was reduced by 45% and the degree of weight fluctuation was lessened. Potassium levels and BUN were controlled to their appropriate level for subjects who initially exceeded the criterion level. With the withdrawal of weight gain from the contingency system, increase of weight gain between dialysis sessions was noted for all subjects.     

Effects of differential negative reinforcement on disruption and compliance

We examined the effects on compliance of two types of differential negative reinforcement (DNR) with a 5-year-old girl with a history of severe disruption. During DNR (communication), escape from instructional trials was provided contingent on a communicative behavior. During DNR (compliance), escape was provided contingent on compliance. Both interventions decreased inappropriate behavior and increased appropriate behavior. However, during DNR (communication), compliance rarely occurred.     

A method to establish stimulus control and compliance with instructions

We evaluated a unique procedure to establish compliance with instructions in four young children diagnosed with autism spectrum disorder (ASD) who had low levels of compliance. Our procedure included methods to establish a novel therapist as a source of positive reinforcement, reliably evoke orienting responses to the therapist, increase the number of exposures to instruction–compliance–reinforcer contingencies, and minimize the number of exposures to instruction–noncompliance–no reinforcer contingencies. We further alternated between instructions with a high probability of compliance (high‐p instructions) with instructions that had a prior low probability of compliance (low‐p instructions) as soon as low‐p instructions lost stimulus control. The intervention is discussed in relation to the conditions necessary for the development of stimulus control and as an example of a variation of translational research.