Diabetes have to respond to the following health requests:
- Give themselves injections of insulin, on a regular basis, using the correct dosage and in a hygienic way.
- Regular tests for the level of glucose in the blood.
- Eat on a regular basis and regulate the intake of carbohydrates.
- Visit a health centre for a general check up on a regular basis.
- Take regular exercise.
- Avoid alcohol, as this lowers the level of sugar in the blood.
Wing et al, in 1986, found the following about non-compliance diabetes. 80% were having unhygienic injections, 58% were administering themselves the wrong dosage of insulin, 75% were on an inappropriate diet and 75% were not on a regular diet. This suggests that adherence can be affected by the amount of activities that a patient has to perform, such as inject themselves with insulin injections, take oral medication and maintain a healthy diet.
In general, the more a client is required to do, the more likely compliance will suffer.
Barbara Korsch and her colleagues have examined the link between patient’s satisfaction with paediatric care and compliance. The researchers interviewed several hundred mothers at a walk-in clinic immediately after they left the doctors office. Most mothers reported being at least moderately satisfied with the visits. However, nearly one-fifth said they did not receive clear statements of what was wrong with their children and about half did not know what caused the illnesses. Their main complaints were that the physician did not seem to respond warmly or sympathetically to their anxiety about their children. One mother, for instance, felt that the doctor didn’t pay an adequate amount of attention to her concern that the convulsions her child experienced may cause brain damage.
After the medical consultation, the researchers visited the mothers to determine the adherence with the recommended regimes. This assessment was done through the mother’s reports and, when possible through pill counts or contacts with the pharmacy where the drugs where obtained from. It was discovered that those mothers who were very pleased with the doctor’s concern and communication of information were three more times likely to adhere closely to the regimes than those who were dissatisfied.
What has been found out about adherence from this piece of research is that health workers play a huge role in whether or not a patient complies to medical requests. If they show little emotion and do not seem encouraging then this is likely to decrease the trust the patient has in the doctor and thus decrease adherence rates.
One other factor, which affects a patient’s adherence, is whether or not the health worker presents the information in a way that he or she will be able to recall the info at a later stage when needed. If a patient cannot recall how to follow their medical treatment, how can they adhere to it? Ley et al, in 1973, investigated how accurately people can remember medical statements. A list of medical statements was given to patients attending a clinic and were asked to recall the list. The statements were either presented in an unstructured way or were procede by information about how they would be organised. For example, a structured presentation may involve the researcher saying, “I willl tell you three things: firstly, what is wrong with you, secondly, what tests we will be doing and thirdly what is likely to happen to you.” When tested to see how much they could recall, it was found out that the subject patients were generally poor at remembering the statements and that structuring the information had made a significant difference on how much they could recall. The patients who were presented information with a structured form remembered 25% more than those who had received the same information but in an unstructured way.
What this says about adherence is that the way a health worker communicates and presents information to their patient has a big affect on whether or not they adhere or not. Information presented in an organised and structured way is more likely to be remembered and therefore increase adherence rates because the patient would be less likely to forget the medical advice given.
- Evaluate this evidence
An evaluative issue concerning Barat et al’s study regarding the link between patient understanding and adherence is that the findings cannot be generalised to other patients of different ages or patients with a different type of medical regime, for example short term regimes. The sample used is not representative of younger patients and patients with other types of medical regimes which is a disadvantage since more investigations would be needed to be made before any generalisations can be made. This is time consuming and can be expensive For example, young patients may be more adherent as they may have understood more of the information that their doctor presented and have a better memory than old people, meaning that they are more successful at recalling information at a later stage when needed unlike old people who have cognitive problems.
Unlike Barat et el’s study which was conducted in 2001, Wing et al’s study was conducted in the year of 1986. This is a weakness of the study now since it was such a long time ago. The findings cannot be applied practically to situations now. Back in the year of 1986 there wasn’t as much media coverage and widely available information about diabetes as there is today. Persons with diabetes may not have had the support that diabetics have today, as there are now newly formed support groups, for example and may have had less information about the way in which they were to administer the dosages of insulin through injections, for example or how to go about maintaining a healthy diet. Nowadays, people have access to the Internet, for example, which has thousands of websites for persons with diabetes with newly found information and treatments to help diabetics deal with their illness.
Let et al’s study regarding the way in which medical advice affects adherence has potentially very useful information concerning how information should be presented to a patient in order to improve their compliance. However, the study lacks ecological validity, since it does not measure true to life behaviour. How often does one get asked to recall a list of medical statements when visiting their general practitioner? The study is about list learning, not about the actual consultation. The patients may not have paid much attention to the test as they would to the consultation with their doctor. They are more likely to pay attention to what the doctor tells them and try to remember it all. Therefore, can this study really be applied to practical situations?
C) Based on the above evidence, suggest one-way health workers can improve adherence.
One way in which health workers can improve a patient’s adherence is to present the information given by the health worker in a structured and organised way so that the patient is able to recall the advice later on when it is needed. If the patient cannot recall the information then they will not be able to adhere to the treatment.
