What do we have to change to achieve greater adherence?

Abstract

The person with diabetes is, ultimately, the one responsible for its management. Health professionals may guide and support them, but they cannot make decisions on their behalf. From that lens, the aim is to help them commit to self-care. There exist numerous barriers to that commitment, some of which are psychosocial in nature. I propose that the health professional take these barriers into account and try to reduce the impact they have over the adherence behavior of their patients. Some such barriers include: a) emotional factors (distress, depression, anxiety, etc); b) motivational factors; c) belief systems built around the condition; d) feeling of self-efficacy.

It is advisable to detect, in each person, the barriers that get in the way of adherence and address them if possible, deriving to other professionals otherwise. For instance, with respect to the emotional factors, the first task would be early detection, assessment of intensity, and derivation to a mental health professional if the situation wasn't addressable in-consult. It is paramount to include, in the attention protocols, the use of standardized questionnaires about the emotional management of the patient. About motivation, my proposal invites the health professional to dive deeper into the aspects that influence it. They should understand that motivation can't be given or prescribed, but it can be stimulated. Furthermore, they should take into account that the person must: believe they have a need to address, believe that it's up to them to address it, believe they are capable of addressing it. Only by exploring these and other characteristics of motivation can the health professional direct their efforts to the right track. They should probe the perception of the person with diabetes about their condition. This will allow them to dispel, re-orient, and re-focus the incorrect beliefs that get in the way of adherence.

About self-efficacy, the professional should make clear how, in occasion, the person might feel at the mercy of the whims of diabetes. Feeling that they have the tools to self-manage the condition helps prevent passivity and despair. Amongst the resources that can strengthen the adherence to treatment are the constant diabetological education and establishing a stable support system (including mutual support groups). Another valuable resource is an early derivation to a mental health professional to help them with stress management techniques, cognitive behavioral therapy, or psychotherapy in the cases that require it.