Communication and adherence in the Caribbean: teaching skills for concordant management of care

ABSTRACT

Effective treatment of contemporary chronic and communicable illnesses can require increasingly complex degrees of adherence. This means that new approaches should be developed to manage the age old problem of adherence or, as it is often called, compliance with medical protocols. Promotion of care-giver and patient concordance as a partnership to address these contemporary concerns must include the development of the requisite communication skills. Within the Caribbean culture, lack of adherence may be exacerbated by a number of issues, including patients' literacy levels, religious and cultural beliefs, perceptions of health care providers, and even attitudes to generic medications. The differences that exist among individual patients/clients, and among the health care providers require the identification and management of the psychosocial factors and communication skills influencing adherence in the Caribbean context. Unfortunately, the exploration of these issues and the teaching of communication skills have not been a standard part of traditional educational programmes for health care providers in the Caribbean. In the introduction to Medical Practice curriculum and as part of the personal and professional development theme, medical students at the University of the West Indies (UWI), Mona, Faculty of Medical Sciences, are asked to examine their experiences of adherence to medical treatment in order to identify common issues as well as those unique to certain patient populations. The issues commonly identified as affecting compliance with medical protocols include the personality of the provider, misunderstanding of instructions, the impact of side effects, and the cost of the medication. Students are then taught four key communication skills geared to increase their competencies in communicating with their patients. These are organizational skills, rapport building skills, data gathering skills, and patient education and management skills. The factors affecting adherence to therapy are examined, such as the patient's condition, treatment prescribed, the clinician, the patient and socioeconomic conditions. The importance of the relationship (including the level of trust and confidence shared) and the quantity and quality of the communication between the patient and the provider are stressed. This chapter makes recommendations on how to improve communication competencies and techniques for effective adherence management. It addresses, in particular, opportunities within the curriculum for supervised communication skills training especially with clinical settings.