Education, psychology and ‘compliance’

Abstract

Those working with patients with diabetic foot wounds are well aware that individuals who take a considerable time to heal pose ongoing challenges for health care professionals and informal carers; cycles of breakdown, recurrent infections, pain management, and adherence to treatment all require regular reassessment, renegotiation of care goals, and review of care plans. Those patients with ulcers for many years are clearly hard-to-heal and often reach a state where the wound is 'static'-not always with any apparent reason. Whilst such scenarios lead professionals to feel exasperated by the lack of progress-how often do we fully consider what this must be like from the patient's point of view? This article will focus on aspects of educational research and health psychology that can lead to a clearer understanding of ways in which professionals can negotiate with patients and empower them to take more responsibility for their own health, within a framework that clearly distinguishes between 'compliance', 'adherence', and 'concordance'. Motivation is fundamental to adherence; the key to developing individual motivation is personal self-awareness and knowledge. However, education on its own will not lead to behaviour change. Readiness to change, confidence in having the necessary skills and family support are key factors when structuring behavioural change programmes.

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…There are two concepts to consider when exploring non-adherence to treatment regimens: unintentional and intentional, and in each case, it is important to determine the cause of non-adherence before commencing efforts to address it. 118,119 Unintentional non-adherence applies when patients have an inadequate understanding of the disease or treatment regimen to competently complete the given tasks, whether due to poor literacy skills, lack of affordability, poor comprehension, reduced cognitive function, not acknowledging the seriousness of the condition due to lack of pain or other causative factors. Cognitive function must be considered since increased prevalence has been documented in patients with DFU.…”

“…120,121 As the day-to-day care of the wound rests in the hands of the patient, reviewing our behavior, as clinicians, in order to engage, empower, and provide an optimal patient-centered experience for our patients has been shown to influence healing. 118,119 Simple education and knowledge exchange strategies can be effective when managing people who unintentionally do not follow advice, and it is the responsibility of the clinician to ensure the patient is equipped with adequate information and that the type of communication is optimized and individualized. Advice and instructions need to be: · Clear and unambiguous; · Use nontechnical, everyday language; · Limited to three or four major points during each discussion; · Include written materials to support information; · And involve the patient's family members and friends.…”

“…Advice and instructions need to be: · Clear and unambiguous; · Use nontechnical, everyday language; · Limited to three or four major points during each discussion; · Include written materials to support information; · And involve the patient's family members and friends. 118,119 However, education and information alone will not always address the cause of non-adherence, particularly in the case of intentional non-adherence. Intentional non-adherence is a complex and at times incredibly frustrating encounter for clinicians.…”

“…Intentional non-adherence is a deliberate and purposeful choice of patients to modify or reject treatment regimens for reasons important to themselves. 118,119 As with all human behavior, progress can be cyclic, with individuals oscillating between making positive progress in their behavior change to "regressing" back to previous negative behaviors. Determining their motivation for doing so is the key to improving adherence.…”

An overview of temperature monitoring devices for early detection of diabetic foot disorders

“…Insufficient understanding of the disease and low adherence to treatment is a well recognized problem in diabetes care and patient education and selfcare must therefore be prioritized [24,25].…”