Page 204 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Social Support 179

According to this model, concordance is regulated by the
patient, who monitors their treatment in light of these five
attributes. For example, a patient with a leg ulcer whose ill-
ness identity includes symptoms such as pain, exudate and
malodour will monitor the use of compression bandages,
evaluating how this affects these symptoms. If the desired
effect – reduced pain, exudate and malodour – is realized in
the timeline the patient anticipates, so reducing the conse-
quences of the ulcer (e.g. reduced mobility, embarrassment)
they will maintain treatment behaviour because they believe
the treatment is effective and has given them control over
illness progression. If these symptoms do not reduce, then the
patient may, for example, begin to doubt the efficacy of the
prescribed intervention (Charles 1995 ) and stop engaging in
treatment behaviours. As Moffatt ( 2004a, b ) notes, a patient’s
previous experience with wound care therapies will impact
on their attitudes towards, and beliefs about those therapies
and their subsequent concordance.
Patients’ beliefs about their condition and aims for treat-
ment re often at variance from those who are treating them;
for example, clinicians may see healing as the priority, whilst
the patient’s priority might be to reduce pain and feel com-
fortable (Morgan and Moffatt 2008 ). Likewise it has been
demonstrated that patients frequently fail to understand the
underlying cause of their wound and that until this is tackled
healing will not take place (Edwards et al. 2002 ). Awareness
of these five cognitive dimensions can help the clinician to
understand how the patient makes sense of their illness and
its treatment, thereby promoting a more patient centred
approach to care.

Social Support

Research suggests that positive social support is very effec-
tive for boosting concordance (DiMatteo 2004 ). Likewise
a lack of social support can reduce the likelihood of treatment
concordance; for example, Stewart et al. ( 2000 ) linked high