Can Dynamic Visual Models Lead to Better Treatment Adherence?

How can pharma marketers help reinforce clear, interactive communication across a patient population? Health researchers are exploring the use of visual communication strategies to support patients to better understand their condition and treatment so they are more inclined to engage in appropriate self-management behaviors.

Patients’ Understanding of Illness and Treatment

Each patient has their own beliefs and ideas about the nature and cause of their illness, and how it will affect them over time.1 Patients use these beliefs to judge their need for treatment, whether it is working—and whether to adhere to the prescribed schedule. These beliefs are important determinants of self-management behaviors, including treatment adherence2 and functional recovery.3 To date, the majority of work in changing patients’ representations of their illness and treatment has focused in the area of patient education, typically delivered verbally in consultation with a healthcare professional and/or presented in print or online. While these approaches can be effective, they are often hampered by the inadequacy of language to explain complex medical concepts.

Researchers are investigating how patients’ perceptions of illness and treatment can be changed through the use of visual and dynamic patient materials. These insights can be applied to support self-management across all chronic conditions.

Recent Innovations That Enhance Patient Understanding

Renal Disease: One early study in this area was conducted among patients with end-stage renal disease, for whom phosphate control, managed through daily use of phosphate-binding medication, is an important aspect of treatment.4 Adherence to these medications is problematic, and many patients don’t understand what this treatment is for, particularly as it does not have any overt impact on their symptoms.

  • The investigators used a “plastic stomach” to demonstrate the mode of action of phosphate-binding medication.
  • The plastic stomach was a transparent plastic stomach-shaped container into which the investigator poured phosphate solution, asking patients to imagine this was their favorite high-phosphate food.
  • Patients were encouraged to describe what they saw, with prompting to articulate the binding action.

The impact of this intervention was compared to a control group which received a pamphlet describing the rationale for medication and the mode of action. Patients randomized to the plastic stomach group had a greater understanding of the problem of high-phosphate levels and of the efficacy of phosphate-binding medication, which was maintained at four-month follow-up.

Osteoporosis: Another interesting study was conducted among patients with osteoporosis.5 Because osteoporosis doesn’t always have obvious symptoms, many patients find it hard to understand the need for treatment.

  • The investigators used 3-D models of healthy and osteoporotic bones as a tool to change patients’ perception of the disease and improve initiation of bisphosphonate treatment.
  • Patients in the study were randomized to receive either a standard medical interview or one augmented by the use of 3-D bone models.

The incorporation of bone models into a medical consultation increased the proportion of participants who started using oral bisphosphonates. Patients who viewed the bone models also reported a greater understanding of osteoporosis at two-month follow-up, in comparison with the control group.

HIV: For patients with HIV, researchers used patients’ most recent blood test results to provide a moving pictorial representation of the patient’s CD4 count and viral load in a smartphone application.6 Protective barriers around the CD4 lymphocytes were made up of each of the antiretroviral medications the patient was taking.

  • When any medication dose was missed, the protective barrier corresponding to that medication would break down and the virus would begin attacking the CD4 lymphocytes.
  •  This model provided the patient with a real-time picture of their level of immune protection against the HIV virus, and demonstrated consequences of medication non-adherence.

When compared to control patients, patients who received the augmented application showed a significantly higher level of self-reported adherence to their antiretroviral medications at three months and decreased viral load.

What Does This Mean?

The use of illness and treatment-related imagery can make a health condition more concrete, supporting patients to better understand the disease process and the importance of self-management behaviors, such as medication adherence. Moreover, these interventions are cost effective, scalable, and can be readily employed in health consultation.

These studies represent an exciting new era of health communication. Pharma would be wise to explore this intriguing area of research and consider how they can incorporate visual tools to augment their patient education and empower patients to better self-manage for the long-term.

References:

1. Reynolds, L., Broadbent, E., Ellis C.J., Gamble, G., & Petrie, K.J. (2007). “Patient Drawings Illustrate Psychological and Functional Status in Heart Failure.” Journal of Psychosomatic Research, 63, 525–532.

2. Broadbent, E., Donkin, L., & Stroh, J.C. (2011). “Illness and Treatment Perceptions are Associated With Adherence to Medications, Diet, and Exercise in Diabetic Patients.” Diabetes Care, 34(2), 338–340.

3. Scharloo, M., Kaptein, A.A., Weinman, J., et al. (2000). “Patients’ Illness Perceptions and Coping as Predictors of Functional Status in Psoriasis: A 1-year Follow-up.” British Journal of Dermatology, 142, 899–907.

4. Karamanidou, C., Weinman, J., & Horne, R. (2008). “Improving Haemodialysis Patients’ Understanding of Phosphate-binding Medication: A Pilot Study of a Psycho- educational Intervention Designed to Change Patients’ Perceptions of the Problem and Treatment.” British Journal of Health Psychology, 13, 205–214.

5. Stephens, M.H., Grey, A., Fernandez, J., Kalluru, R., Horne, A., Faasse, K., & Petrie, K.J. (2016). “3-D Bone Models to Improve Treatment Initiation Among Patients with Osteoporosis: A Randomized Controlled Pilot Trial.” Psychology and Health, 31, 487–486.

6. Perera, A.I., Thomas, M.G., Moore, J.O., Faasse, K., & Petrie, K.J. (2014). “Effect of a Smartphone Application Incorporating Personalized Health-related Imagery on Adherence to Antiretroviral Therapy: A randomized Clinical Trial.” AIDS Patient Care and STDs, 28, 579–586.

  • John Weinman, PhD

    John Weinman, PhD is Head of Health Psychology at Atlantis Healthcare and Professor of Psychology at King’s College, London. Professor Weinman is recognized as one of the founders of modern health psychology and respected as a preeminent global thought leader in the field. His main research areas are cognition and health, communication and decision-making in healthcare, and self-management and self-regulation in chronic illness.

    • Kate Perry

      Dr. Kate Perry, MSc, PsychD, MNZPB is Director, Behavioral Science at Atlantis Healthcare. A registered psychologist with 20 years experience in the healthcare sector, Dr. Perry is responsible for the development of global evidence-based programs to promote behavior change among individuals living with chronic conditions.

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