Knowledge is a prerequisite, but education alone will not guarantee adherence. Behavioral strategies should also be implemented to increase the likelihood of adherence.
The key issue of behavioral interventions is to assist adolescents with rheumatic disease in learning adequate self-management. Self-management can be defined as the individual's ability to manage the symptoms, treatment, physical and psychosocial consequences of lifestyle changes inherent in living with rheumatic disease (83). Efficacious self-management encompasses ability to monitor one's condition and to affect the cognitive, behavioral, and emotional responses necessary to maintain satisfactory quality-of-life. Thus, a dynamic and continuous process of self-regulation is established.
Interventions to increase self-efficacy may help to increase confidence with self-management. Bandura recommended the following four primary strategies for increasing self-efficacy with medication taking (57,85):
1. Try to identify and reinforce the patient's past and present successes or accomplishments.
2. Direct the patient to observe successful behaviors of others.
3. Provide positive feedback for the patient's efforts or encourage people in the patient's social network to do so.
4. Clinicians can try to ensure that their patients do not interpret incorrectly how they are feeling. Assist in emotions hindering adherence with medication taking.
If possible, poly-pharmacy should be avoided by reducing the complexity of treatment (16). Linking medication taking with some other well-established daily activity and tailoring the medication regimen to the lifestyle of the adolescent may assist (16,51). Reminders (e.g., alarm clocks, programming mobile phones, medication calendars, vibrating watches) and self-monitoring strategies (e.g., daily logs) may also helpful. Dispensing incentives for adherence is another behavioral strategy (69).
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