Influencing patient adherence to treatment guidelines.

BACKGROUND: As chronic disease continues to weigh more heavily on health care resources, lifestyle management and compliance to treatment become paramount to patient care and care coordination. Although a wealth of information is available to the public regarding the basic tenets on exercise, nutrition, weight management, power of medications, and so forth, patients do not always modify their behavior accordingly to improve their overall health. Motivation seems to be both the key element as well as the central puzzle in efforts to change behavior.
OBJECTIVE: To identify several strategies, including motivational interviewing, that can be used to reduce resistance and improve the odds of achieving positive clinical outcomes among noncompliant/resistant patients.
SUMMARY: Providers once thought the following about nonadherent patients: They don't see (are in denial or lack insight), they don't know, they don't know how, and/or they don't care. However, instead of focusing on the reasons why people do not change, researchers in behavior change science recognize that the best questions to ask are: "Why do people change?" and "What can we do to help?" A worst-case scenario undermining positive clinical outcomes is one in which the provider is arguing for change while the patient argues against it. It is, therefore, more effective to enlist strategies that address the complex interaction of motivations, cues to action, perception of benefits and consequences, expectancies, environmental and cultural influences, self-efficacy, state of readiness to change, ambivalence, and implementation intentions. Motivational interviewing is one such approach that is evidence based and increasingly well proven. Motivational interviewing is a client-centered, goal-oriented method for enhancing intrinsic motivation to change by exploring and resolving ambivalence, and it offers more than simply wellintentioned advice or scare tactics.
CONCLUSION: A client-centered approach is the most important component of a health coaching skill set. Patients can ascertain whether you are truly attempting to understand their situation instead of merely trying to manipulate them into change. Respecting each patient's autonomy, drawing out ambivalence about change, evoking change talk, and allowing the patient to develop and/or own the treatment plan greatly improve the odds of achieving positive clinical outcomes.