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Shanmughan Chettyar S.1, Grafton K.2
1Sheffield Hallam University, Center for Health and Social Care Research, Sheffield, United Kingdom, 2Sheffield Hallam University, Department of Allied Health Professionals, Sheffield, United Kingdom
Background: Adherence to therapies is a primary determinant of treatment outcome. Poor adherence to the treatment have not only affects the patient's clinical outcomes but also is a cost to the health care system. A varieties of factors are likely to affect adherence, of which sociocultural elements are considered to be a key influence. Sociocultural factors for non-adherence are very contextually dependent. This study examines the sociocultural factors that influence patient adherence in south Indian physiotherapy settings.
Purpose: To identify underpinning socio-cultural elements that are associated with patient adherence in south Indian outpatient physiotherapy settings.
Methods: An ethnographic approach was used to observe the interactions between patient and therapist in a public and a private sector in Indian physiotherapy out-patient department in Kerala. Data was collected using field note observations (12 private sector and 11 public sector): 29 audio recorded interactions between patients and therapists (15 private sector and 14 public sector) and 21 informal interviews individually with patients and therapists (11 private sector and 12 public sector). Data was coded and analysed by using thematic analysis.
Results: Seven key themes that reflected the sociocultural element of adherence were identified; which include affordability, accessibility, belief, social responsibility, awareness, gender issues and attitude. Lack of sufficient physiotherapy provision in government hospitals and the unaffordable cost of physiotherapy treatment in private sectors were recognised as the main reasons for non-adherence of patients from below the poverty level. A strong belief in traditional medicine like ayurvedham was also identified as a cause for non- adherence. Family obligations, role expectations and responsibility of males and females in Indian society often did not allow the individual to prioritise the regular attendance at physiotherapy treatment sessions. A lack of awareness about physiotherapy, different attitudes of patients toward their life and towards symptoms also acted as a barrier to patients adherence. A lack of female therapists to treat female patients was also recognised as a sociocultural issue associate with non-adherence.
Conclusion(s): The themes formed from this study provide information about the sociocultural barriers that currently affect the adherence of patient to physiotherapy treatment in India. This study included participants both from the private and public sectors and so reflects the sociocultural adherence issues across different socioeconomic classes with in southern Indian society. These findings from this study stress the need of better support from health care providers especially in terms of accessibility and cost, education to patients and their families and awareness about the gender issues for health care professionals.
Implications: Knowledge of these social factors provides an opportunity for the service providers individually and collectively to consider what steps may be taken to enhance the treatment adherence optimise treatment outcome. Also it informs policymakers so that they may effectively address the identified barriers. At an international level these findings may be used by service providers to inform service provision to meet the needs of south Indian communities living overseas.
Funding acknowledgements: Self-funding
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval: Centre for Health and Social Care Research, Sheffield Hallam University, UK, Medical College Hospital Thiruvananthapuram, India, MTH, Ernakulum, India.
All authors, affiliations and abstracts have been published as submitted.
