‘A lack of time’ has long been identified as a key barrier to treatments in an early prospective study (Alexandre et al., 2002). In this study, barriers, such as busy working schedules, a lack of time, needs for child care, financial constraints are found to associate with poor patients’ adherence. These barriers are personal and individualised. In general, male patients tend to report busy working schedules and laziness being their main barriers to rehabilitation, whereas the female patients are more likely to quit a program due to family obligations and their commitments to family, work and community activities.
While a number of personal barriers can inhibit patients’ participation in rehabilitation, many of these are predictable. It is described by Giuliani (2002) that a good leader is able to identify potential problems and prepare relentlessly before barriers happen. In order to do this, clinicians need to first appreciate patients’ diverse values and cultural responsiveness. All patients’ perspective and conditions should be treated with respect. As reasons for non-adherence are individualised and multi-factorial, a patient’s individual preferences and social characteristics, such as working schedules and family situations, should be considered by clinicians during treatment planning to maximise one’s possible participation (Jones et al., 2007).
Leadership is a people activity and is much more complex than planning activities. This is to say, after planning, leaders should engage followers to actively involve in the pursuit of shared plans. To do this, the Health LEADS Australia (HLA) model encourages leaders to engage others with the use of explanations and encouragements (Health Workforce Australia, 2013). One-to-one meetings and cognitive-behavioral training, such as motivational interviews, can be used to optimise the communicative process and reduce one’s perception of barriers (Gohner & Schlicht, 2006). It is also proved in a systematic review by Tierney et al. (2012) that cognitive behavioral strategies, such as education about problem-solving skills and motivational interviews can improve patients’ confidence in continuing exercise programs. Improved self-efficacy could also positively influence patients’ persistence and willingness to engage in a program. The ultimate goal of engaging patients is for each person to take responsibility to follow the plan and achieve the desired outcome.
Also, is it about having time or making time for rehabilitation? Setting appropriate goals can improve one’s self-management skills and long-term adherence to treatment (Pozehl et al., 2014). Rost (1993) argues that leaders and followers should keep an independent relationship and collaborate together towards shared goals. An important aspect of this is that leaders should influence followers to share a common vision with them. This idea of setting goals and implement goal-oriented plans aligns with another key focus of ‘achieves outcomes’ in the HLA. Planning how, when and where a plan can be implemented will increase the chance of performance of an intended behavior (Gollwitzer, 1999). Therefore, for patients, especially those who drop out due to their busy schedule, clinicians should set realistic and motivating goals together with them to determine how rehabilitation programs could fit into their lives.
Alexandre, N. M. C., Nordin, M., Hiebert, R., & Campello, M. (2002). Predictors of compliance with short-term treatment among patients with back pain. Revista Panamericana de Salud Pública, 12(2), 86-95.
Conraads, V. M., Deaton, C., Piotrowicz, E., Santaularia, N., Tierney, S., Piepoli, M. F., & Jaarsma, T. (2012). Adherence of heart failure patients to exercise: barriers and possible solutions. European journal of heart failure, 14(5), 451-458.
Giuliani, R. W. (2002). with Ken Kurson. Leadership.
Gohner, W., & Schlicht, W. (2006). Preventing chronic back pain: evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain. Patient education and counseling, 64(1), 87-95.
Health Workforce Australia (2013, July). Health LEADS Australia: the Australian Health Leadership Framework. Retrieved from https://www.aims.org.au/documents/item/352
Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American psychologist, 54(7), 493.
Jones, M., Jolly, K., Raftery, J., Lip, G. Y., & Greenfield, S. (2007). ‘DNA’ may not mean ‘did not participate’: a qualitative study of reasons for non-adherence at home-and centre-based cardiac rehabilitation. Family practice, 24(4), 343-357.
Pozehl, B. J., Duncan, K., Hertzog, M., McGuire, R., Norman, J. F., Artinian, N. T., & Keteyian, S. J. (2014). Study of adherence to exercise in heart failure: the HEART camp trial protocol. BMC cardiovascular disorders, 14(1), 172.
Rost, J. C. (1993). Leadership for the twenty-first century. Greenwood Publishing Group.