Engagement And Concordance - Psychosocial Flashcards
Compliance
Extent to which a persons behaviour coincides with medial or health advice
Healthcare professional take the lead
Comply with instructions
Obedience
Passive behaviour
Blame for non-compliance lies with patient
One way relationship
Adherence
Extent to which a persons behaviour corresponds with agreed recommendations from a health care provider
Non-judgemental
Patients involved
Patients assume a more active and informed role
Professional directed
Adherence failure
Fail to take medication as required
Missed medical appointments
Skipped rehabilitation exercises
Not following lifestyle advice
Concordance
Process of developing a mutually agreed treatment plan
Partnership and agreement between patient and healthcare professional
Shared decision
Therapeutic alliance or co-creation
Consequences: economic
Waste of medical resources
Costly treatment side effects e.g. reoccurrence of symptoms
Repeated doctor and specialists visits
Consequences: clinical
Health care regimens will not work if patient chooses not to adhere to
Adherence is associated with positive health outcomes
Many diseases and illnesses are only preventable or treatable if treatment protocols are followed
Intentional versus non-intentional adherence
Up until 1970 viewed as ignorant or forgetful
Result of a rational decision being influenced by a cosy benefit analysis
Cons - side effects, disrupts lifestyle, financial cost, labelled as ill/disables, lack of trust
Pros - improvement of symptoms, relief in long term
Barriers to adherence: Jack et al. (2010)
Low levels physical activity
Low in-treatment adherence
Low self-esteem
Depression and/or anxiety
Helplessness
Poor social support
Greater perceived barriers
Increased pain during exercise
Barriers and predictors of adherence: spink et al. (2011)
Podiatry intervention for prevention of falls
153 people, mean age 74.3
Adherence - 69% foot inserts, 54% footwear advice, 72% exercises
Greater adherence - better physical health, less fear of falling, younger
What can influence adherence behaviour
Social factories - education, unemployment, low social support
Psychological factors - high anxiety and depression, coping style, interruption to daily life
Treatment factors - misunderstandings, complexity, side effects, little obvious benefit, poor health professional relationship
Assessing adherence
Direct and indirect measure
Patient centred approach means the patients views and reasons for non-adherence provides a valuable perspective
Multi-faceted
Normalising non-adherence
Non threatening
Suggest rational and blame free explanation
Patient see other people can be in a similar situation
Assessing adherence: direct measure
Biomedical - blood and urine analyses
Pill dispensers/ pill counts
Electronic measures
Problems - not always accurate, pills thrown away, expensive and intrusive, not practical in clinical setting
Assessing adherence: indirect measure
Directly asking the patient - self-report measures
Seeking information from significant others
Advantage - cost effective, ease and speed
Problems - response bias, inaccurate recall
Problematic experiences therapy scale (PETS)
Kirby, Donovan-Hall, Yardley (2014)
Measure self-reported perceived barriers to adherence to physical rehabilitative exercises
Patient-centred approach
Promoting engagement
Good communication
Education
Share resources
Provide easily accessible assistance
Identify and address barriers
Recognise all patients and their experiences are unique
Work in partnership with patient, family and other health professionals
Good communication
Open discovery questions
Listen more than talk
Use how and/or what
Encourage their own solutions
