Achieving compliance in chronic illness management: illustrations of trust relationships between physicians and nutrition clinic patients

Abstract

This paper presents empirical research from a study of trust and co-operation between chronic illness patients and their physicians, conducted in nutrition clinics. The paper details models of trust and co-operative behaviour designed to aid interpretive analysis. The paper then presents an interpretive discussion of 16 examples from interactions observed between patients and their consultants at the initial visit and revisit stage of the illness management process in consecutive clinics. This illustrates some of the ways interpersonal trust development between patients and their physicians may affect health care delivery. The paper finds physicians appear to make in-clinic opportunities for building resilient trust relations with patients based on common understanding and experience, engendering more rapid patient compliance. This is further promoted by a contemporaneous positive focus on key issues, such as patient-perceived importance and patient-perceived self-competence, serving to lower patient co-operation thresholds. In the best instances, the combined effect is significant patient empowerment, and thus improved health care delivery as a result of the compliance thereby achieved. In addition, it is suggested the speed of trust development during the interactions is not commensurate with long term relationship sustainability, and suggests this as an explanation for, amongst others, failure to attend rates.

Keywords:

• interpersonal trust
• compliance
• chronic illness
• risk

Notes

Department of Management, University of Lincoln, Canterbury, New Zealand

A new parent's compliance with a midwife, for example, would be expected to decrease over time as their own perceived competence increases, raising their co-operation threshold (‘parent knows best’). This may be so even in neo-natal intensive care scenarios, as the risk to the child's health diminishes. For compliance to continue health care professionals may need to engender more and more significant forms of trust, such as Knowledge Based Trust, to overcome a rising co-op. threshold. We are grateful to Karen Tosh of the Centre for Public Policy Management at the University of St Andrews for pointing this out in conversation.

Additional information

Notes on contributors

Mark R Dibben*

Department of Management, University of Lincoln, Canterbury, New Zealand