Caring for themselves: facilitators and barriers to women home care workers who are chronically ill following their care plan.

Compliance literature has paid little attention to the ability of patients to carry out their care plan. Indeed, throughout this literature, the voices of patients are disturbingly absent. In this paper, I report a study of compliance issues among women home care workers who were chronically ill. Twenty-nine women participated in five focus groups. They were asked to share perspectives on what helps, what hinders, and how their health care providers were either facilitators or barriers to their care plan. Key findings were identified through a qualitative content analysis. My findings suggest that perspectives on compliance, which do not begin with an understanding of factors affecting compliance within the individual's control, are unrealistic. For these women, following a care plan required being sufficiently motivated and having necessary supports. Supports were identified as good doctor-patient communication, adequate financial resources, time and ability to attend to their care, and spirituality. Yet, even if all supports were in place, if participants did not have a stated motivation (i.e. sufficient reason to follow their care plan), they continued to go through the motions. My study suggests that recognizing the personal context of chronic illness may be what motivates patients to follow their care plan. This finding can be used by providers for patient assessment, and may help to form a foundation for empathic communication.