The role of psychological science in efforts to improve cardiovascular medication adherence.
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2018-11
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Abstract
Poor adherence to cardiovascular disease medications carries significant psychological, physical, and economic costs, including failure to achieve therapeutic goals, high rates of hospitalization and health care costs, and incidence of death. Despite much effort to design and evaluate adherence interventions, rates of adherence to cardiovascular-related medications have remained relatively stagnant. We identify two major reasons for this: First, interventions have not addressed the time-varying reasons for nonadherence, and 2nd, interventions have not explicitly targeted the self-regulatory processes involved in adherence behavior. Inclusion of basic and applied psychological science in intervention development may improve the efficacy and effectiveness of behavioral interventions to improve adherence. In this article, we use a taxonomy of time-based phases of adherence-including initiation, implementation, and discontinuation-as context within which to review illustrative studies of barriers to adherence, interventions to improve adherence, and self-regulatory processes involved in adherence. Finally, we suggest a framework to translate basic psychological science regarding self-regulation into multicomponent interventions that can address multiple and time-varying barriers to nonadherence across the three adherence phases. The field of psychology is essential to improving medication adherence and associated health outcomes, and concrete steps need to be taken to implement this knowledge in future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Bosworth, Hayden B, Dan V Blalock, Rick H Hoyle, Susan M Czajkowski and Corrine I Voils (2018). The role of psychological science in efforts to improve cardiovascular medication adherence. The American psychologist, 73(8). pp. 968–980. 10.1037/amp0000316 Retrieved from https://hdl.handle.net/10161/28705.
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Daniel Blalock
I am a research scientist and Licensed Clinical Psychologist with a background in health services research, clinical psychology, and experimental psychology. My research interests include 1) the evaluation of current integrated behavioral health settings in health care systems to optimize future implementation efforts, 2) the development of novel integrated behavioral health strategies tailored to specific populations and healthcare system needs, 3) broad processes of behavior change and self-regulation, and 4) psychometric measurement of patient reported outcomes and research methods/statistics.
These interests have taken the form of specific research endeavors involving: a) large nonrandomized investigations of electronic health records data, b) development and evaluation of telehealth interventions to improve self-management of mental and physical health behaviors, and c) evaluation of patient-reported outcomes through telehealth modalities and in primary care, specialty care, and higher level of care settings.
To date, the content domains of most of my research have involved substance use (specifically alcohol, opioids, and tobacco), health behaviors (specifically medication adherence), mental health (specifically anxiety, depression, PTSD, and eating disorders), and health services utilization.

Rick Hoyle
Research in my lab concerns the means by which adolescents and emerging adults manage pursuit of their goals through self-regulation. We take a broad view of self-regulation, accounting for the separate and interactive influences of personality, environment (e.g., home, school, neighborhood), cognition and emotion, and social influences on the many facets of goal management. Although we occasionally study these influences in controlled laboratory experiments, our preference is to study the pursuit of longer-term, personally meaningful goals “in the wild.” Much of our work is longitudinal and involves repeated assessments focused on the pursuit of specific goals over time. Some studies span years and involve data collection once or twice per year. Others span weeks and involve intensive repeated assessments, sometimes several times per day. We use these rich data to model the means by which people manage real goals in the course of everyday life.
In conjunction with this work, we spend considerable time and effort on developing and refining means of measuring or observing the many factors at play in self-regulation. In addition to developing self-report measures of self-control and grit and measures of the processes we expect to wax and wane over time in the course of goal pursuit, we are working on unobtrusive approaches to tracking goal pursuit and progress through mobile phones and wearable devices.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.