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, 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.
