Adherence in Clubfoot Treatment
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, Rucha Gadgil, Meaghan Rieke, Olajumoke Ogunleye and Oyemi Sillo
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 nonadherence is directly related to relapse.[1] [2]
Reasons 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]
Clinic Staff can do a lot to Promote Adherence:
- Recognize 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.
