Getting non-adherent patients to listen to and dialogue with adherent patients can improve adherence

The Annals of Internal Medicine recently published the results of the study “Culturally Appropriate Storytelling to Improve Blood Pressure”. The randomized, controlled trial involved 299 patients who received a series of 3 DVDs (delivered at baseline, 3 months, and 6 months) — “Patients in the intervention group received DVDs that contained patient stories. The comparison group received an attention control DVD that covered health topics not related to hypertension.” In short, the researchers were seeing whether listening to hypertension stories would help these patients.

The researchers concluded:

The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension.

As reported by Dr. Pauline Chen in the NY Times “When Patients Share Their Stories, Health May Improve”:

“Telling and listening to stories is the way we make sense of our lives,” said Dr. Thomas K. Houston, lead author of the study and a researcher at the University of Massachusetts Medical School in Worcester and the Veterans Affairs medical center in Bedford, Mass. “That natural tendency may have the potential to alter behavior and improve health.”

Without taking anything away from this excellent study, all it did (which was a lot!) was get patients to listen to stories. Imagine if there had been more — listening, feedback, questions … in short, a story followed by a dialogue. The affect of each story would have been that much more powerful!

Take this story telling and dialogue concept to the problem of adherence (i.e. getting patients to take their medications as directed by their physician) — Have patients who are not adherent to their medication listen to the stories of and dialogue with patients who are adherent to their medication.

Has it been done? Unfortunately, I can’t point to a clinical trial (if you can, please pass it along!), but I can point to one of several case studies.

Boxcutters Jewel #523 – Getting non-adherent patients to listen to and dialogue with adherent patients can improve adherence.

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Comments
11 Responses to “Getting non-adherent patients to listen to and dialogue with adherent patients can improve adherence”
  1. Ben Garrett says:

    I think storytelling is an effective way to influence behavior in general. With patient non-compliance as big a problem as ever, this is an innovative and cost-effective solution to the problem. When the healthcare provider can’t spend the time to “tell the story”, using a method like a DVD makes a lot of sense. I bet there are some case studies out there somewhere!

  2. Michael Wong says:

    Comment from Dr Bridget Kirsop, a retired Doctor and now a Life Coach — website supportingwomendoctors.co.uk; twitter @Womendoctors —

    As an NLP coach – I am amazed at the power of metaphors – if you tell someone a story that resonates with them, resistance goes !!

  3. Dr. John says:

    I’m not aware of any studies looking at storytelling influencing adherence. It’s a great idea that could be studied.

    As doctors we always moan about patients being “non-compliant” or now the PC term “non-adherent.” But other than the emerging quality metrics and P4P many doctors don’t really care if their patients don’t take their meds–there are just too many patients, and enough that follow our instructions to keep us going. In a sense, we “cut our losses.”

    It’s looked at as “the patient’s problem.” Blame the victim. Of course, I can see where the insurance plan or the drug company would want better adherence–to minimize future claims and keep pill sales flowing.

    Thus, adherence would improve if doctors, insurance cos and hospitals were all on the same page….sounds a lot like accountable care!

    -Dr. John

    http://glasshospital.com

  4. Hi Michael, as you know, I really like your response about this research. In general communicating needs to be a much more recognized form of healing and support for good quality of life. We are social creatures and knowing we are not alone is a huge factor that promotes all sorts of healing, including taking better care of ourselves. As I mentioned in my blog (http://trialx.com/curetalk/2011/02/connecting-others-help-lower-high-blood-pressure/), managing and tracking complex, and open sharing is something that probably evades the scientific method, but perhaps in time, there will be techniques available that will allow open sharing as an actual treatment for healing and compliance/adherence.

  5. Michael Wong says:

    A sales specialist at a speciality pharmaceutical writes:
    “No studies I am aware of. But, understanding the science behind story telling communication complience would be a natural evolution of increased understanding. Toastmasters public speaking group has a manual devoted to the art of storytelling. As a pharm representative, story telling to the doctor as a real sense of reality. The same is for a patient from my ER experience and when I encourage a practicioner to realy important information to a patient with a sense of wonder and importance.”

  6. Thanks Michael. I hadn’t seen this research yet. As someone who works solely in healthcare communications and does a lot around adherence, I would agree that there is something here. It’s not unlike some research that CatalystRx shared around how they are using avatars to engage patients.

    Stories are usually more engaging and more memorable to consumers. These could be an effective way to cut through the clutter of communications and engage consumers to think differently about their condition.

  7. Jeanne Male says:

    No studies per se but I have anecdotal evidence from facilitating diabetes awareness (and distributing tools for adherence) in churches and senior centers. I didn’t need to tell the stories but rather simply craft the right questions and provide a collaborative learning environment for the non-adherent patients to hear the stories of the adherent (previously non-adherent) patients. The net effect (only measured by verbatims) was a shift in the attitudes and beliefs of non-adherent patients. I did not do psychometric entry/exit but I do so in my training practice and have measured how attitudes and beliefs do indeed drive behaviors independent of ongoing reinforcement, however, when available, the reinforcement (whether education, tools or motivation) are more effective. I feel confident that clinical outcomes were impacted but again, my experience is only anecdotal.

  8. As a human race we have a need to be connected to each other. These connections can influence our lives and help us to cope and make decisions.
    Blogging is very much about sharing and connecting with others. This digital form of story-telling has been a beneficial tool for me personally in coping with lateral violence, and also growing as a nurse.
    It seems fairly obvious that when a patient is able to hear the story of another patient, to hear how they are not alone, then they will feel less hesitancy in facing their medical problems.
    After snow has fallen, and the road is no longer visible, the journey can be made easier when you follow the tracks already laid in the snow.

  9. Michael Wong says:

    For further thoughts on storytelling and adherence, as well as how Dr Jay Pomerantz (assistant clinical professor of psychiatry at Harvard Medical School) has used storytelling to improve adherence, please see http://wp.me/p1fYJ7-9Y

  10. Michael Rooney says:

    I don’t have clinical references, but it might be wise to look into Behavioral Health Certified Peer Specialist data. In Pennsylvania, Medicaid reimburses for these services. Reimbursement status is predicated on success as an evidence based practice.
    While CPS duties are in place across the spectrum of BH care, at their core is listening and sharing. By exhibiting that wellness can be achieved CPS have and are providing support to patients in crisis, providing an example of what a personal wellness journey can look like.

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