Promoting Adherence to Iron Chelation Treatment in Beta-Thalassemia Patients

Figures & data

Figure 1 Health Belief Model.

Notes: Adapted with permission from John Wiley and Sons. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education. Theory, Research and Practice. San Francisco: Jossey-Bass; 2002; permission conveyed through Copyright Clearance Center, Inc.⁷⁵

Table 1 Attachment Styles, Attempted Coping (Behaviour) and Strategies for Health Care Professionals

Attachment Style (Patient)	View of Self (Patient)	Potential Emotional Consequences (Patient)	View of Caregivers	Attempted Coping	How Caregivers Might Feel/ Think	Adherence -Related Engagement Strategies for HCPs
Secure Low relational anxiety/ Low avoidance of intimacy	Loveable & worthy of care Self-confident	Expressive	Accepting & responsive Trustworthy &available Able to provide care as needed	Assertive & expressive Able to ask for help as and when needed, with relative ease	Comfortable Helpful	Unlikely to have challenges in developing rapport
Insecure: Preoccupied High relational anxiety/ Low avoidance of intimacy	Un-loveable and unworthy of care Self-doubt Low-self-confidence and low self-esteem Self-concept derived from others	Anxious Sadness Frustration Disgust	Trustworthy & availabl	Assertive & expressive, at times autocratic Pursuit of acceptance from others Able to ask for help with frequent help- and reassurance-seeking	Desired/ needed Helpful Frustrated	Offer regular, contact with boundaries Provide opportunities to build self-efficacy/ self-confidence Positive reinforcement through reminders of positive changes
Insecure: Dismissive-avoidant High avoidance of intimacy/Low relational anxiety	Loveable & worthy of care Independent Self-confident	Emotionally distant Cold Frustration	Unreliable Untrustworthy/ Unhelpful Unimportant Incapable of providing care when needed - Capable of providing care when pressurised	Strong focus on independence and self-reliance Avoidance of vulnerability in relationships and dismissive of intimacy Minimal self-disclosure and expressiveness	Desire to help Rejected Unhelpful Frustrated Unsure	Provide consistency in your contact – do not overpromise Regularly & consistently invite and support expressions of issues/ concerns Provide opportunities for group/ peer/ social support Manage expectations for change
Insecure: Fearful-avoidant High avoidance of intimacy High relational anxiety	Un-loveable and unworthy of care Self-doubt Low-self-confidence and low self-esteem Self-concept derived from others	Anxious Sadness Frustration Disgust	Rejecting Unreliable Untrustworthy Incapable of providing care when needed	Avoidance of intimacy and close involvement with others as protection against rejection, disappointment and harm from others (eg frequent cancellations, non-attendances) Minimal self-disclosure and expressiveness Self-concept is derived from others	Desire to help Frustrated Hopeless Unhelpful Unsure	Provide consistency in your contact and minimise barriers to attendance (eg more frequent, brief telephone/ video consultations) Set boundaries for attendance and positively reinforce attendance Regularly & consistently invite opinions and feedback Provide opportunities to build self-efficacy/ self-confidence Positive reinforcement through reminders of positive changes Provide opportunities for 1:1 peer/ social support Manage expectations for change

Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education. Theory, Research and Practice. San Francisco: Jossey-Bass/Wiley and Sons; 2002.

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