The Role of Nutrition, Lifestyle, and Compliance with Chronic Disease

Proper nutrition, medication adherence, and healthy lifestyle choices are key elements to preventing and managing chronic disease.  While physicians recognize that lifestyle interventions can be useful to patients with chronic illnesses, many don’t have the adequate amount of time required to incorporate it into the time they spend with each patient. Additionally, these are often the most difficult changes for individuals to make[1] and it can be difficult to encourage compliance between office visits. As a result, alternative methods of providing general wellness information need to be leveraged to ensure patients are engaging with their care plan recommendations and adopting lifestyle changes as needed.

Increasing Nutrition & Lifestyle Compliance

New routines are a struggle for everyone however giving careful instructions to people with long-term illnesses can increase compliance.[2]

Health instructions for new regimens generally incorporate a few different factors including prescriptions, exercise, and nutrition.  Most patients will not adopt all the suggestions at once – they may adhere to one or two suggestions at a time.  If instructions are complex, patients are less likely to follow them.  It’s important to make recommendations easy to understand and easy to follow. It’s equally important that the importance of the activity as it relates to the desired outcome is conveyed.[3]  Patients are more compliant when they understand the impact of their behavior.

Enhancing Nutrition Education & Services for Patients

Chronic Care Management (CCM) programs can be leveraged as a tool to increase awareness, engagement, and compliance between office visits – ensuring proper nutrition and lifestyle choices are being carried through the care plan. Well-run CCM programs already take social and economic factors into account, which have a significant impact on lifestyle choices.   For example, while some patients might only require proper education others might need the help of available social services to get transportation or meal services.

CCM programs can help coordinate the available social services that assist in making lifestyle changes easier to adapt and maintain. 

A recent study by researcher Milton S. Davis, Ph.D., F.A.P.H.A. found that the patient-doctor relationship is an important factor for compliance and, interestingly, there is little association between what occurs during the primary visit and later compliance. It is the subsequent visits and behavior that determined compliance.  Regarding subsequent visits, the data suggests that: “compliance is a function of a delicate balance of direction and evaluation presented in a manner which is acceptable to the patient.”  This concept can and should be seen reflected in any chronic care management program, where patients are consistently evaluated and directed on best health practices.

There are a number of other factors that affect compliance, including;

Tension-release / Laughing

Research has shown that releasing tension through positive communication such as joking and laughing leads to higher compliance rates.

Looking beyond the physiological issue

When doctors and medical staff ask about, and take into account, the psychological and social elements of the patients’ lifestyle – it helps make better recommendations based upon that information that the patient is more likely to comply with.[4]

Using non-judgemental language and showing sensitivity[5]

This could include acknowledging to the patient that a lifestyle change is often difficult, and perhaps even using questions like “Would you be willing to try…” instead of phrases such as “You should’ve been doing…”

Maintain a sense of warmth, and provide explanations

This will create higher patient satisfaction and therefore higher compliance rates.[6]

Persistence is Key

While communicative delivery styles are certainly an important part of enhancing patient compliance – persistence is also key. One nurse gives the following synopsis: “The nurse’s responsibility is to persist; that is, attempt to find out why the patient isn’t complying, urge the patient to comply, repeat the explanation of the necessity for compliance, continue to teach the patient, and enlist other healthcare providers to reinforce the advice.”[7]  It may be challenging for a practice to find the time and resources to enact this strategy, which is why outsourced chronic care management programs serve such a useful purpose in this scenario.  By outsourcing CCM, patients have the opportunity to hear from a nurse consistently, so that they can be educated and re-educated on how to improve their health while also tying together other facets of care, including their medications, care team, and social services options.

Despite the high prevalence of chronic diseases and the difficulty with compliance — we believe patients can achieve better health outcomes through CCM programs that foster greater education and engagement.

Sources

[1] https://www.stjhs.org/healthcalling/2017/july/the-doctors-advice-most-often-ignored-by-patient/

[2] Abramson, J. H.; Mayet, F. G.; and Majola, C. C. What Is Wrong with Me? A Study of the Views of African and Indian Patients in a Durban Hospital. South African M. J. 35:690-694 (Aug. 19), 1961.)

[3] https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.58.2.274

[4] https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.58.2.274

[5] https://www.specialistlanguagecourses.com/medical-english-tips-giving-advice-sensitively/

[6] https://www.nejm.org/doi/full/10.1056/NEJM196903062801004

[7] https://www.medscape.com/viewarticle/808934

 

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