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Behavioural interventions have been shown to be comparatively more effective at improving adherence than other modalities (Boczkowski generic silvitra 120mg on line discount erectile dysfunction drugs, Zeichner & DeSanto 1985; Falloon order silvitra 120mg on line erectile dysfunction exercises, 1984; Zygmunt et al purchase silvitra with mastercard erectile dysfunction age 25. Cognitive and motivational interviewing interventions have also been studied discount 500 mg amoxil with amex, to a lesser extent than other interventions purchase 80 mg top avana with mastercard, with mixed results (Gray et al apcalis sx 20mg visa. In the present study, interview data overwhelmingly contraindicated the utility of a generalised, “one size fits all”, pre-determined intervention to address adherence amongst consumers. This finding could explain why previous intervention studies have reported only limited success in terms of improving adherence. Interviewees in the present study justified their 290 opposition to such interventions through constructions of adherence as a personal issue, influenced largely by consumers’ unique experiences. This is consistent with the findings of other qualitative research (Carrick et al. Adherence was frequently described as a process which involves experiential learning, and is thus, mediated by a variety of factors at different stages of the illness, which differ for individual consumers. Adherence could, thus, be seen to encompass a complex interaction of influences, which may change over time. Furthermore, adherence decisions were frequently framed as rational choices based on the information and resources available to consumers. Interviewees acknowledged that in some instances, non-adherence not only represents a logical choice, but it may be the best option for consumers, contrary to assumptions in the literature (and arguably the healthcare setting) that adherence is always positive and should be strived for. Additionally, adherence and non-adherence experiences, including associated consequences, were often constructed as learning opportunities. Many interviewees reported that non-adherence experiences, in particular, reinforced the benefits of taking medication. Furthermore, they posited that resistance (or non-adherence) may allow consumers to actively question and participate in their treatment plans, in line with the present findings. Results of the present study, therefore, highlight the limited effectiveness of prescribers and other health workers imposing or encouraging adherence amongst consumers who do not themselves perceive 291 adherence as desirable or appropriate. For example, interviewees indicated that when medications failed to treat symptoms or produced intolerable side effects, adherence is neither an attractive nor a beneficial option. A more extreme example of the bodily effects of medication rendering adherence unsuitable is treatment-resistant schizophrenia. Prescriber intervention to encourage adherence in such instances was generally seen to reflect failure to take into account the consumer experience and, according to consumers, can result in non-adherence as resistance. Interviewees proposed that a more effective prescriber approach may involve asking about and acting on the consumers’ concerns about the medication schedule and addressing concerns, by changing medications, for example. Similarly, for consumers who lack insight in relation to their illness and/or the need for medication, non- adherence may also typically represent a logical choice. Interviewees suggested that experiencing the consequences of non-adherence can actually be beneficial when there is a lack of insight, as it highlights the need for medication and can provide a reference point to motivate future adherence. It could be argued that peer workers, whose role in assisting with adherence was largely endorsed by interviewees, may also have a useful role in encouraging adherence amongst consumers who lack insight.

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