Adherence to rehabilitative programmes by patients living with neurological conditions : a South African context

Abstract

The number of people living with disabilities is increasing. Good adherence to rehabilitative programmes is critical for optimal health and health systems in developing countries are under pressure to meet multiple health needs. Overworked practitioners assume that if the patients fail to show up for their appointments they have lost interest. The purpose of the study was to explore reasons for the poor adherence of patients with neurological disorders at rehabilitative services. This study used a phenomenological approach and purposive sampling. One-on-one interviews with patients booked to receive therapy at a South African public sector hospital and who failed to attend therapy were done (n=12). For triangulation purposes interviews were conducted with patients who had never missed sessions (n=5). A total of eight of the participants from both groups said that they had not accepted their condition. All five dimensions of adherence described in the literature were found. The participants gave very positive feedback on the rehabilitative programmes received at the hospital, but said circumstances beyond their control had caused them to miss a session. These included fear of losing jobs, unavailability of transport, and perception of poor services at primary health care clinics when down referred. The reasons for adherence or lack of it are not easily established. Contributing factors however were noted in this study. Information obtained from the study will assist health professionals to understand the patients’ context and can inform rehabilitation programmes to support adherence.