The Impact of a Training Session on TherapistsÕ Beliefs and Attitudes Regarding Patient Adherence in Outpatient Clinics

Purpose/Hypothesis : Patient non-adherence is a common problem which a majority of rehabilitation therapists and assistants are inadequately prepared to address. The purpose of this study was to determine if a 2-day multi-disciplinary adherence training course was effective in positively modifying rehabilitation cliniciansÕ beliefs and attitudes regarding patient adherence.Number of Subjects : Thirty-two rehabilitation clinicians from 11 outpatient clinics.Materials/Methods : To investigate participant beliefs about the role of the patient-practitioner relationship in affecting adherence, a multidisciplinary panel with expertise in public health, physical therapy, psychology and counseling developed survey questions on a 4-point Likert scale. Content validity was established through internal and external review. Participants answered the survey questions anonymously using a handheld ÒclickerÓ immediately before and after a 2 day adherence enhancement course taught by the expert panel. The presented strategies included barrier reduction, motivational interviewing, cognitive-behavioral and behavior modification techniques. Belief changes from baseline to post-training were assessed using Wilcoxon signed-rank tests. The effectiveness of the course was also evaluated through descriptive analysis of direct participant feedback.Results : Thirty-two clinicians, mean age 38.9 (SD 7.7, 63% female), completed the course and agreed to participate. Wilcoxon signed-rank tests demonstrated changes in therapistsÕ beliefs for 7 of the 15 adherence concepts (P<0.05), all of which were in favor of strategies to improve adherence. The clinicians expressed decreased agreement that the therapistÕs skill level (P=0.02) and patientÕs motivation (P=0.3) individually were most important for successful outcomes, increased agreement that therapy works by eliciting the clientÕs own ability to change (P=0.02), that therapists should emphasize coping skills (P=0.01), and that empathy improves adherence (P=0.01). Participants also agreed more after training than at baseline that they had sufficient time to address patient adherence (P=0.01) and showed increased disagreement with the concept that previously non-adherent patients would not change despite the clinicianÕs efforts (P=0.0). Those beliefs not demonstrating statistically significant changes were in favor of adherence concepts at both baseline and post-training. All respondents said they would recommend an adherence training course to their colleagues.Conclusions : The training course positively impacted therapistsÕ beliefs regarding patient adherence. Therapists felt confident and motivated to use their new skills. Such belief changes are precursors to behavior change and future research should investigate if they lead to improved adherence outcomes.Clinical Relevance : Adherence enhancement appears to be teachable. Perhaps additional training in adherence enhancement should be taught in entry-level or continuing education curricula.

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  • Control #: 1726211
  • Type: Poster
  • Event/Year: CSM2014
  • Authors: Katherine L. Long, Jennifer Reneker, Melisa Barden, Carrie VanMeter, Megan B. Donaldson
  • Keywords: Patient Adherence|Clinician Adherence|Education

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