Barriers To Learning


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Barriers To Learning

  1. 1. Facilitating Adherence How to get your patient to do what you want them to do
  2. 2. Asking a patient to do an exercise program is asking them to change their behavior
  3. 3. Patients don’t change their behavior because they suddenly have adequate knowledge <ul><li>The patient must </li></ul><ul><li>choose to change, </li></ul><ul><li>know when to enact the plan, </li></ul><ul><li>have the psychomotor skills to perform the task, </li></ul><ul><li>be motivated to follow through until the problem resolves </li></ul><ul><li>have adequate resources to follow through. </li></ul><ul><ul><ul><ul><ul><li>(p.328) </li></ul></ul></ul></ul></ul>
  4. 4. All along the way there are barriers to the patient adhering to the plan of care.
  5. 5. The patient must have knowledge and understanding of their condition and of the intervention or prevention program.
  6. 6. Barriers that might prevent this <ul><li>Misconceptions about the nature of a given condition </li></ul><ul><li>Misconceptions about what caused the problem </li></ul><ul><li>Misconceptions about the ability of the patient to prevent the problem </li></ul><ul><li>Poor understanding of the recommended program </li></ul><ul><li>How often to do the treatment </li></ul><ul><li>What to expect from the treatment ie. increased strength, ROM? </li></ul><ul><li>What types of side effects might the treatment have? Ie. Pain, muscle soreness </li></ul><ul><li>How long will it take to see the positive effects? </li></ul><ul><li>What will happen if I don’t take this course of action? </li></ul><ul><li>Patient’s belief system of why illness occurs </li></ul>
  7. 7. The patient must be motivated to make a change. The patient must believe that the incentives for following the program are greater than the cost of not following it.
  8. 8. Barriers that might prevent this <ul><li>Poor understanding of the risks of inaction </li></ul><ul><li>Unable to identify positive outcomes of the intervention </li></ul><ul><li>Therapist identifies the reasons patient must make the change vs. patient identifying them. </li></ul><ul><li>Patient’s locus of control ie. Internal vs. external </li></ul><ul><li>Self-efficacy, self-confidence, patient’s belief that they can accomplish the task </li></ul>
  9. 9. The patient must have adequate resources to make the change. Resources include: monetary, time, human (assistance and/or support), space, etc.
  10. 10. Barriers that might prevent this <ul><li>Socioeconomic status </li></ul><ul><li>Time (both perceived and actual limitations) </li></ul><ul><li>Childcare </li></ul><ul><li>Support from others </li></ul><ul><li>Physical space to perform the exercises </li></ul><ul><li>Physically being removed from negative influences (ie. Working in a McDonalds when you need to lose 40 lbs.) </li></ul>
  11. 11. Certain barriers can impact all three of these
  12. 12. Physical needs <ul><li>Hearing </li></ul><ul><li>Visual acuity </li></ul><ul><li>Impaired mobility </li></ul><ul><li>Pain </li></ul><ul><li>Fatigue </li></ul><ul><li>Eyeglasses, dentures, dressed </li></ul><ul><li>Hot or cold </li></ul><ul><li>Comfort </li></ul>
  13. 13. Cultural barriers <ul><li>Beliefs about illness and wellness </li></ul><ul><li>Access to medicine </li></ul><ul><li>Traditions </li></ul><ul><li>Language </li></ul>
  14. 14. Cognitive barriers <ul><li>Dementia </li></ul><ul><li>Language </li></ul><ul><li>Learning disabilities </li></ul><ul><li>Age </li></ul><ul><li>Educational level </li></ul>
  15. 15. Emotional needs <ul><li>Depression </li></ul><ul><li>Worried about the future </li></ul><ul><li>Patient becomes overwhelmed </li></ul>
  16. 16. Therapeutic Rapport <ul><li>Relationship to and with the clinician </li></ul>
  17. 17. The 5 A’s behavioral protocol helps us to address these barriers and facilitates adherence to our teaching