Page 201 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

176 Chapter 7. Concordance

Finally Kessels notes that there are features specific to
each patient which can impact on what a patient remembers
about treatment needs. This includes factors such as low
education that, as noted earlier, can limit a patient’s under-
standing of instructions. It also includes a patient’s own
expectations of the consultation process, and their beliefs
about health and healing. Indeed, individual factors such as
this have been found to be very important in determining
patient concordance (Snelgrove 2006 ). Ley’s model has
been criticised for not taking the possible influence of
patients’ pre-existing knowledge and beliefs, or life context,
into account. Thus whilst Ley’s model is important because
of it focuses on the dialogue between patient and health
care provider, it has been argued that it is an educational
model, which assumes that the clinician is the expert and the
patient is a novice who needs to be taught what to do
(Snelgrove 2006 ). Any consideration of concordance how-
ever, must recognise issues such as a patient’s health beliefs,
their personal circumstances including social support, and
their sense of control, as these are all factors which have
been shown to affect the extent to which patient’s will fol-
low a treatment plan (Stanton 1987 ).

Health Beliefs, Self-Regulation and Illness
Perception

Concordance acknowledges that whilst the health beliefs of
the patient may be different to those of their clinician, they
are just as relevant when making treatment choices (Dickinson
et al. 1999 ). This is important, since the extent to which some-
one will engage in a health related behaviour (e.g. wound
treatment) depends upon the value they put on the goal of
the behaviour (e.g. wound healing) and their estimate of the
likelihood that the behaviour will achieve that goal (Janz and
Becker 1984 ). Thus according to the health belief model
(HBM) (Janz and Becker 1984 ; Rosenstock et al. 1988 )
concordance with treatment will occur when a patient is: