Doctor-Patient Communication for Adherence to Hypertension Treatment in Nepal

Effective doctor-patient communication is key to addressing the signifi cant issue of nonadherence to hypertension treatment in Nepal. Common clinical messages about hypertension are evaluated utilizing the framework of the Common-Sense Model of Self-Regulation for their role in shaping the patient models that underlie nonadherent behavior. Clinical communications and practices are recommended: to respectfully elicit and address patient reliance on self-identifi ed symptoms; to accompany warnings of hypertension’s serious consequences with specifi c individual action-plans for durable effects; to emphasize the necessity of long-term continuous treatment without creating fears of dependence and withdrawal effects or burdensome monitoring and counseling; to inform of side-effects while presenting medication as nontoxic and necessary for the body’s maintenance of a healthy balance. By acknowledging the patient as an active agent engaged in self-regulation and by employing culturally consonant concepts (often Ayurvedic), we can encourage accurate patientillness and treatment representations that guide medication adherence.

Contextual factors of self-regulation in children and adolescents with chronic diseases – a qualitative analysis

Background In recent decades, the prevalence of chronic diseases in children and adolescents has increased significantly. Contextual factors play a central role in the self-regulation of chronic diseases. They influence illness and treatment representations, disease management, and health outcomes. While previous studies have investigated the influence of contextual factors on children’s beliefs about their illness, little is known about subjective contextual factors of treatment representations of children and adolescents with chronic diseases, especially in the context of rehabilitation. Therefore, the aim of this qualitative analysis was to examine the contextual factors reported by chronically ill children and adolescents in relation to their treatment representations. Furthermore, we aimed to assign the identified themes to classifications of environmental and personal contextual factors in the context of the International Classification of Functioning, Disability and Health (ICF). Methods Between July and September 2018, semi-structured interviews were conducted with N = 13 children and adolescents in rehabilitation to explore their rehab-related treatment representations and associated contextual factors. The interviews started with an open narrative question about expectations and beliefs about rehabilitation, followed by further detailed questions. The interviews were recorded on audio tape, transcribed, and analysed using thematic content analysis. Results Participants raised six themes associated with their rehab-related treatment representations that were interpreted as contextual factors: the living situation before rehabilitation, the idea of rehabilitation, previous solution attempts, rehab pre-experiences, information that the children and adolescents received from the clinic or sought themselves, and the assumed attitudes of their parents concerning rehabilitation. All the themes could be assigned to the classification of environmental and personal factors in the context of the ICF for children and youth. Conclusions Although contextual factors have an important impact on self-regulation, little attention is paid to their investigation. Personal and environmental factors probably influence patients’ treatment representations in terms of expectations and concerns as well as emotions regarding the treatment. Considering contextual factors could lead to the more appropriate allocation of medical care and the better customisation of treatment.

Contextual factors of self-regulation in adolescent medical rehabilitation patients—a qualitative study

Background:In recent decades, the prevalence of chronic diseases in children and adolescents has increased significantly. Contextual factors play a central role in the self-regulation of chronic diseases. They influence illness and treatment representations, disease management, and health outcomes. While previous studies have investigated the influence of contextual factors on children's beliefs about their illness, little is known about subjective contextual factors of treatment representations of children and adolescents with chronic diseases, especially in the context of rehabilitation. Therefore, the aim of this qualitative analysis was to examine the contextual factors reported by chronically ill adolescents in relation to their treatment representations. Furthermore, we aimed to assign the identified themes to classifications of environmental and personal contextual factors in the context of the ICF.Methods:Between July and September 2018, semi-structured interviews were conducted with N=13 adolescent rehabilitants to explore their rehab-related treatment representations and associated contextual factors. The interviews started with an open narrative question about expectations and beliefs about rehabilitation, followed by further detailed questions. The interviews were recorded on audio tape, transcribed, and analysed using thematic content analysis. Results:Participants raised six themes associated with their rehab-related treatment representations that were interpreted as contextual factors: the living situation before rehabilitation, characterised by school and family problems, few social contacts, and intensive media consumption; the idea of rehabilitation, which mostly came from various people in the adolescent’s social environment; previous solution attempts; rehab pre-experiences; information that the adolescents received from the clinic or sought themselves; and the assumed attitudes of their parents concerning the presumed necessity of rehabilitation and expectations regarding the process and its outcome. All the themes could be assigned to the classification of environmental and personal factors in the context of the ICF for children and youth.Conclusions:Although contextual factors have an important impact on self-regulation, little attention is paid to their investigation. Personal and environmental factors probably influence patients’ treatment representations in terms of expectations and concerns as well as emotions regarding the treatment. Considering contextual factors could lead to the more appropriate allocation of medical care and the better customisation of treatment.

Script(ing) Treatment: Representations of Recovery from Addiction in Hollywood Film

American films and television programs increasingly feature characters recovering from addiction. These representations are based on previous depictions and help create a cultural understanding of addicts. This study analyzes the depiction of addicts and addiction in three Hollywood films whose narratives are largely situated within a treatment center: Clean and Sober (1988), When a Man Loves a Woman (1994), and 28 Days (2000). It concludes that the films depict a stock experience of treatment that is surprisingly univocal, as well as unrealistic when compared with the availability and realities of real-life programs. In addition, the films limit their representations of successful recovery to white, upper-class individuals and offer only one conceptual framework for addiction.