Adherence in Clubfoot Treatment: Difference between revisions
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'''Original Editor '''- Africa Clubfoot Training Team as part of [http://www.physio-pedia.com/Clubfoot_Content_Development_Project ICRC and GCI Clubfoot Content Development Project] | '''Original Editor '''- Africa Clubfoot Training Team as part of [http://www.physio-pedia.com/Clubfoot_Content_Development_Project ICRC and GCI Clubfoot Content Development Project] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div><div align="justify"> | </div><div align="justify"> | ||
== Introduction == | == Introduction == | ||
treatment for clubfoot requires the long-term commitment of [[Parents of Children with Cerebral Palsy|parents and caregivers]] in order to achieve a successful outcome. Non-adherence is one of the key reasons for failure of clubfoot treatment. According to Göksan et al, patient and family adherence to brace use is a common problem, as non-adherence is directly related to relapse<ref>Göksan SB, Bilgili F, Eren İ, Bursalı A, Koc E. Factors Affecting Adherence with Foot Abduction Orthosis Following Ponseti Method. Acta Orthopaedica et Traumatologica Turcica. 2014 Dec;49(6):620-6.</ref><ref name=":0">Africa Clubfoot Training Project. Chapter 16 Africa Clubfoot Training Basic & Advanced Clubfoot Treatment Provider Courses - Participant Manual. University of Oxford: Africa Clubfoot Training Project, 2017.</ref>. | |||
== Reasons | == Reasons for non-adherence == | ||
* Beliefs and | * Beliefs and stigma | ||
* Community / | * Community / family pressure to consult traditional healers | ||
* Community / | * Community / family pressure to not continue treatment | ||
* Lack of | * Lack of confidence in treatment | ||
* Lack of | * Lack of understanding about treatment and the full protocol | ||
* Believe | * Believe treatment is finished after casting | ||
* Baby | * Baby cries with cast or braces on | ||
* Poverty - | * Poverty - no money for transport or treatment costs | ||
* Long | * Long distance to clinic | ||
* Lack of | * Lack of support by fathers / families | ||
* Family / | * Family / marital conflict | ||
* Other | * Other responsibilities e.g. child care, work | ||
* Poor | * Poor communication from health workers | ||
* Poor | * Poor relationship with health workers | ||
* Cultural | * Cultural practices e.g. nomadic tribes | ||
* Impatience | * Impatience | ||
* Poor | * Poor appointment tracking and follow-up after missed appointments | ||
* Incorrect | * Incorrect prescription of braces: | ||
** Foot | ** Foot not yet corrected | ||
** Shoe | ** Shoe does not fit well | ||
* Lack of | * Lack of clear instructions on braces: | ||
** Importance | ** Importance | ||
** How to | ** How to fit | ||
** Wearing | ** Wearing protocol <ref name=":0" /> | ||
== How to | == How to promote adherence == | ||
Health care professionals can do a lot to promote adherence: | |||
# Recognise that parents are the most important team members - they must feel they are partners in the treatment process | |||
# Understand that treatment is difficult for parents | |||
# Spend time with parents | |||
#* Build relationship | |||
#* Teach | |||
#* Answer questions | |||
# Parent education and counselling | |||
# Communicate well and check parents understand what you have said | |||
# Target key risk times | |||
#* End of casting | |||
#* Start of bracing | |||
#* Start of night bracing | |||
# Provide simple written information | |||
#* Brochures | |||
#* Booklets | |||
# Treat clubfoot well | |||
#* This raises family’s confidence in staff and treatment | |||
# Encourage fathers & family members to participate in treatment | |||
# Help families problem-solve common problems | |||
# Support costs of treatment | |||
#* Supplies | |||
# Ensure good appointment scheduling, tracking, and follow-up | |||
# Link Families with community agents that may help: | |||
#* Community health workers | |||
#* Social entities | |||
#* NGOs | |||
#* Faith-based organizations | |||
# Promote family-friendly clinics | |||
# Parent advisors / counsellors | |||
# Designate a team member specifically for parent education and support | |||
#* Clinicians are often too busy for this <ref name=":0" /> | |||
== References == | == References == | ||
Revision as of 10:53, 15 November 2017
Original Editor - Africa Clubfoot Training Team as part of ICRC and GCI Clubfoot Content Development Project
Top Contributors - Naomi O'Reilly, Kim Jackson, Rachael Lowe, Simisola Ajeyalemi, Oyemi Sillo, Rucha Gadgil, Meaghan Rieke and Olajumoke Ogunleye
Introduction[edit | edit source]
treatment for clubfoot requires the long-term commitment of parents and caregivers in order to achieve a successful outcome. Non-adherence is one of the key reasons for failure of clubfoot treatment. According to Göksan et al, patient and family adherence to brace use is a common problem, as non-adherence is directly related to relapse[1][2].
Reasons for non-adherence[edit | edit source]
- Beliefs and stigma
- Community / family pressure to consult traditional healers
- Community / family pressure to not continue treatment
- Lack of confidence in treatment
- Lack of understanding about treatment and the full protocol
- Believe treatment is finished after casting
- Baby cries with cast or braces on
- Poverty - no money for transport or treatment costs
- Long distance to clinic
- Lack of support by fathers / families
- Family / marital conflict
- Other responsibilities e.g. child care, work
- Poor communication from health workers
- Poor relationship with health workers
- Cultural practices e.g. nomadic tribes
- Impatience
- Poor appointment tracking and follow-up after missed appointments
- Incorrect prescription of braces:
- Foot not yet corrected
- Shoe does not fit well
- Lack of clear instructions on braces:
- Importance
- How to fit
- Wearing protocol [2]
How to promote adherence[edit | edit source]
Health care professionals can do a lot to promote adherence:
- Recognise that parents are the most important team members - they must feel they are partners in the treatment process
- Understand that treatment is difficult for parents
- Spend time with parents
- Build relationship
- Teach
- Answer questions
- Parent education and counselling
- Communicate well and check parents understand what you have said
- Target key risk times
- End of casting
- Start of bracing
- Start of night bracing
- Provide simple written information
- Brochures
- Booklets
- Treat clubfoot well
- This raises family’s confidence in staff and treatment
- Encourage fathers & family members to participate in treatment
- Help families problem-solve common problems
- Support costs of treatment
- Supplies
- Ensure good appointment scheduling, tracking, and follow-up
- Link Families with community agents that may help:
- Community health workers
- Social entities
- NGOs
- Faith-based organizations
- Promote family-friendly clinics
- Parent advisors / counsellors
- Designate a team member specifically for parent education and support
- Clinicians are often too busy for this [2]
References[edit | edit source]
- ↑ Göksan SB, Bilgili F, Eren İ, Bursalı A, Koc E. Factors Affecting Adherence with Foot Abduction Orthosis Following Ponseti Method. Acta Orthopaedica et Traumatologica Turcica. 2014 Dec;49(6):620-6.
- ↑ 2.0 2.1 2.2 Africa Clubfoot Training Project. Chapter 16 Africa Clubfoot Training Basic & Advanced Clubfoot Treatment Provider Courses - Participant Manual. University of Oxford: Africa Clubfoot Training Project, 2017.
