Hvorfor gør vi ikke det der er bedst for os? Et adfærdsvidenskabeligt studie af patientadhærens i fysioterapi

Karen Staugaard Mejling & Meng Jing Christine Wang

Student thesis: Master thesis

Abstract

Background: Each year, muscular disease and arthropathy cost the Danish society 20 billion DKK which makes this area of disease the second most expensive in Denmark. The treatment of muscular disease and arthropathy often lies within the field of physiotherapists. Physiotherapy treatment generally involves an exercise program where the patient is asked to perform self-managed exercises outside of the consultation, which makes patient adherence an important determinant of the success of the treatment. In this context, research has shown that only approx. 50% of patients follow the physiotherapist’s recommendations, and the number is even lower when it comes to unsupervised home exercises. Therefore, the purpose of this dissertation is to examine the influencing factors on the patients’ exhibited degree of adherence in physiotherapy in order to come up with solution strategies for improving the treatment approach.
Methods: In order to do so, we have collected data from a survey as well as six interviews with physiotherapists and six interviews with patients. The purpose of the survey is to provide an overview of the problem area before conducting a more in-depth examination using the interviews. The purpose of the interviews is to investigate the experience with patient adherence more extensively and from the perspective of both health provider and patient.
Findings: Using a behavioral scientific perspective, this dissertation finds that patient adherence is affected by numerous patient factors including present bias, bounded cognitive capacity, experienced level of pain, level of self-efficacy, social influence, the relationship with the physiotherapist and ability to self-rationalize.
Conclusion: The analysis finds the dominant view within physiotherapy to have a fundamental assumption about human nature as being rational. However, the shown behavioral patterns of the patients indicate that they are more likely to be influenced by bounded rationality in their decision making in terms of whether or not they should exhibit patient adherence. In order to address this discrepancy between health provider and patient, this dissertation has arrived at four solution strategies aimed at the physiotherapist that take the patients' actual behavior and way of thinking into account. These strategies consist of linking the exercise program to an existing routine, using short-termed and specific goal setting, reducing the distance between the patient’s current and future self, and utilizing their sense of cognitive dissonance associated with non-adherence.

EducationsMSc in Psychology, (Graduate Programme) Final Thesis
LanguageDanish
Publication date2020
Number of pages106
SupervisorsHenrich Dahlgren