PAPA™: Don’t Preach

August 2016

The Perceptions and Practicalities Approach (PAPA™) works by conceptualising nonadherence as a complex behaviour. A complex behaviour can have multiple causes, in the same patient, at any one time. Those causes can be intentional, when the patient actively chooses not to adhere as a response to their beliefs or perceptions. Or the causes can be unintentional, when the patient faces some practical barrier to optimum adherence.


We design our programmes according to our proprietary framework (PAPA™), which outlines the key features most likely to ensure the programme’s efficacy. These essential features address the perceptions underlying medicines behaviour, i.e. their motivation to adhere. These key features also address the practicalities facilitating or hindering optimal adherence, i.e. the patient’s ability to adhere.


We tailor the support needed to the needs of the individual. When patients feel that their perspective has been taken into account, they are more likely to engage with an adherence support programme, because they don’t feel preached to or, even worse, preached at.


Programme design is more precarious than it seems. If you address the wrong perceptions (how patients perceive the risks of their illness rather than of their treatment), you will generally fail, because perception alone cannot mediate adherence behaviour. If you assess perceptions without addressing them, you will generally fail as your efforts at meaningful communication with the patient will fall short of directly dismantling the barrier.


If you do not refine your strategy to target the salient barriers to be overcome, for example by using practical solutions to resolve perceptual barriers (or vice versa), you will generally fail because communication will ring hollow. For best effects, we use PAPA™ in tandem with our other approaches and frameworks to design an effective, constantly-evolving adherence support programme, co-created with patients, that makes the most of your medicine.


So when you want to transform adherence? PAPA™, don’t preach.