Motivation: An important factor in adherence to home programs for patients with chronic conditions

By Kristin Domville, DrOT, OTR/L and  Kaye Rubio, Ph.D., MHS, OTR/L, CLT-LANA,

Chronic medical conditions are long-term diseases that affect people of all ages, social classes, and ethnic groups. It is estimated 6 out of 10 adults in the United States have a chronic condition, such as heart disease, diabetes, arthritis, and/or chronic obstructive pulmonary disease (Centers for Disease Control, 2021; Connors et al., 2019). Patients with chronic conditions face many different challenges as they adjust to living with these conditions, including but not limited to coping with symptoms, stress, and disability; managing complex medication regimens; maintaining proper levels of nutrition, diet, and exercise; adjusting to psychological and social demands; making necessary lifestyle adjustments; and adapting to work.

Occupational therapists provide clients with home programs to help them manage their chronic conditions and adapt to the challenges they face in relation to these conditions in order to assist the individual in performing daily activities. The management of chronic conditions becomes part of the person’s daily activity of health management, which falls under the occupation domain of the Occupational Therapy Practice Framework (American Occupational Therapy Association, 2020). Examples of home programs practitioners provide include home exercise programs to improve strength and endurance; consistent use of an adaptive device to simplify daily activities; implementing orthoses and/or compression garments to increase range of motion and reduce swelling; and energy conservation techniques to reduce shortness of breath and conserve energy.

Despite education, individuals with chronic conditions sometimes may not adhere to therapy recommendations, like home and self-management programs, as they are overwhelmed due to the everyday changes associated with the condition and onset of disability. For instance, adherence to home programs related to lymphedema management can be as low as 13 to 19 percent (Alcorso et al., 2016; Brown et al., 2015). Adherence is defined as “the degree to which patients and research participants act in accord[ance] with the advice of the clinician or researcher” (Radomski, 2011 p. 471), and adherence in relation to self-management programs is the process a person undergoes when changing their behavior, lifestyle, and/or routines (Grady & Gough, 2014). Compliance to recommended therapy programs needs to be addressed when treating clients with chronic conditions, however clinicians must also be aware a person needs to be motivated to undergo these changes and unfortunately chronic conditions can alter an individual’s motivation (Muraca et al., 2011; de las Heras et al., 2003). Occupational therapy practitioners can use several approaches to influence a client’s level of motivation in order to impact their interest in taking care of themselves and increase their willingness to adhere to home and self-management programs provided during therapy.

The Transtheoretical Model of Change explains how change occurs in five stages and motivational interviewing uses these stages to outline approaches that occupational therapists can utilize in order to alter a client’s level of motivation to partake in therapy (Muraca, et al., 2011). The Remotivation Process is an intervention approach based on the Model of Human Occupation, which can be used as a guide during a practitioner’s interaction with the client to facilitate progression from exploration to the achievement stage of motivation (Muraca, et al., 2011).

Application to practice: Occupational therapists provide home programs and self-management with the intent of helping clients manage the impact of chronic conditions has on their ability to participate in meaningful daily activities. However, adherence to these programs can be challenging if the person is unmotivated. Motivation plays a key role in changing behavior, which in turn influences adherence, so occupational therapy practitioners should include the use of motivational strategies, such as tailoring recommendations to the needs and abilities of the client and their level of motivation, to help facilitate compliance with recommended home programs.

References

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