Using Patient Experiences of Health Management Occupations to Guide Research on Medical Adherence

Title: Using Patient Experiences of Health Management Occupations to Guide Research on Medical Adherence Topic: Examining the construct of medical adherence through the lens of occupational science Purpose/Aims: Adherence originates from medical science literature and is a revision of the earlier concept of compliance. Modern conceptualization of adherence integrates feedback from patients and expands the patient’s role in directing care. Yet still, medical advice is privileged above patient perspectives maintaining providers in the role of expert. Little is known about how patients’ lived experiences of adherence fit within their occupational experience of health management. In this panel, we will explore the dialogue between the medical perspective of adherence and the lived occupational experiences of patients seeking to heal from an injury or manage a chronic disease. Presentation #1 Methods: Using a review of the literature, Presenter 1 compares the constructs of adherence, compliance, patient-provider communication, and partnership. Result: Evidence in this area remains sparse. We argue that the transactionalism (Cutchin & Dickie, 2012) framework within occupational science is poised to assist in improving patient and provider relationships, and support the occupation of health management through research. Presentation #2 Methods: Presenter 2 reports on emergent qualitative findings from a multi-phase, mixed methods study that explored the impact of rheumatic disease on young adults’ occupational engagement. Young adults (n=12) were individually interviewed using a semi-structured guide. Based on iterative analysis, three participants were then purposively recruited to each complete a series of four additional follow-up narrative interviews. Result: Data revealed diverse experiences when young adults collaborated with rheumatologists to find tailored medication regimens while also exploring strategies to maintain a normal life. Presentation #3 Methods: A mixed-methods, case series was completed with 16 patients receiving care at an outpatient hand therapy clinic. Qualitative data was collected via individual, semi-structured interviews across the patients’ episodes of care, and quantitative survey data was collected after each therapy visit. Result: Quantitative data revealed that therapists rated patients as highly adherent and engaged with little variation. However, patients’ perspectives revealed disparate amounts of engagement in therapy because of the interaction between home life and assigned home exercise. Argument/Importance to Occupational Science: Experience-near accounts of patients provide a contextualized perspective of medical treatment. This reveals how adherence fits as a component of the occupation of health management, and expands current understandings of adherence in order to support patients in future applied occupational science research. (397 Words) Key Words: Transactionalism, Health Management Occupations, Adherence, Engagement Objectives for Discussion: Does the current literature as discussed in presentation 1 on adherence accurately describe the construct as patients experience it as seen in presentations 2 and 3? How so? How do the results of presentation 2 and 3 fit with or contradict frameworks in Occupational Science (e.g. Transactionalism, Systems Theory)? What is the opportunity for applied Occupational Science in reframing the medical research on adherence? What are the next steps with this line of work (e.g., development of a model, development of outcome measures for engagement or adherence)