Causes of Patient Non Compliance In Nursing Education
Impact of Illiteracy on Motivation and Compliance
In addition to the fact that poor literacy skills affect the
ability to read as well as to understand and interpret the meaning of written
and verbal instructions, a person with illiteracy or low literacy struggles
with other significant inter related limitations with communication that can
negatively influence healthcare teaching (Doak et al., 1998; Kalichman,
Ramachandran, & Catz, 1999; Vagvolgyi et al., 2016). The person's
organization of thought, perception, vocabulary and language/fluency
development, and problem solving skills are adversely affected, too
(Giorgianni, 1998).
Characters of Literary Disabled Person In Nursing Education
Fleener and Scholl (1992) investigated characteristics of persons who had identified themselves as literacy disabled. Vagvolgyi et al. (2016) conducted a comprehensive review of the literature to define what it means to be functionally illiterate and to uncover answers to questions about deficits in abilities, such as sensory, cognitive, and neurological, of those identified with one or more causes of illiteracy. These two groups of researchers found that among the functionally illiterate, the most common deficiencies found were in phonics, comprehension, and perception.
Difficulties in perception were evident in reversing letters and words, miscalling letters, and adding and omitting letters. Also, a major problem was comprehension that is, identification of words without knowing their meaning. Some individuals needed to read aloud to understand, and others read so slowly that they lost the meaning of a paragraph before they had finished it. Still other subjects perceived difficulty in remembering as a factor in their lack of reading skill.
Educational Difficulties of Illiterate People In Nursing
People with poor reading skills have difficulty analyzing instructions, assimilating and correlating new information, and formulating questions (Giorgianni, 1998). They may be reluctant to ask questions because of concerns that their inquiries will be regarded as incomprehensible or irrelevant. Frequently they do not even know what to ask, but they fear if they try, others will think of them as ignorant or lacking in intelligence. These individuals have great difficulty navigating the healthcare delivery system.
Which relies on written information and printed forms at every juncture.
Studies have shown that Health Insurance Portability and Accountability Act
(HIPAA) privacy notices, informed consent forms, drug warning labels, and
insurance forms all present obstacles for individuals with poor reading skills
(Davis et al., 2006; McCormack, Bann, Uhrig, Berkman, & Rudd, 2009; Sudore,
Landefeld et al., 2006; Walfish & Ducey, 2007).
Most nurses can recount a situation in which a patient failed to follow advice because he or she did not understand the instructions that were given. Hussey and Guilli land (1989) provide a poignant example, which remains as relevant today as it was then, of a young pregnant girl prescribed antiemetic suppositories to control her nausea. When she had no relief of symptoms, questioning by the nurse revealed that she was swallowing the medication.
Obviously, not only did she not understand how to take the
medicine, but she also likely had never seen a suppository and was not even
able to read or understand the word. She did not ask what it was, probably
because she did not know what to ask in the first place, and she may have been
reluctant to question the treatment out of fear that she would be regarded as
ignorant.
If their past experiences with learning have been less than
positive, some people may prefer not knowing the answers to questions and may
withdraw altogether to avoid awkward or embarrassing learning situations. Also,
they may react to complicated, fast-paced instruction with discouragement,
feelings of low self-esteem, and refusal to participate because their process
of interpretation is so slow. Even when questioned about their understanding,
persons with low literacy skills will most likely claim that they understood
the information even when they did not (Doak et al., 1996).
Another characteristic of illiterate individuals is that they have difficulty synthesizing information in a way that fits into their behavior patterns. If they are unable to understand a required behavior change or cannot understand why it is needed, they will disregard any health teaching (Vanderhoff, 2005; Weiss, 2007).
For example, patients recovering from
fractured hips who are taught via demonstration and written instructions how to
climb stairs and how to do strengthening exercises may fail to comply with this
regimen because of lack of understanding of the information and ways to go
about incorporating these changes into their lifestyle (Schultz, 2002).
Persons with poor literacy skills may also think in only concrete, specific, and literal terms. An example of this limitation is the patient with diabetes whose glucose levels were out of control even when he insisted, he was taking his insulin as instructed injecting the orange and then eating the fruit (Hussey & Guilliland, 1989).
The person with limited literacy also may experience difficulties
handling large amounts of information and classifying it into categories.
Particularly, older adults who need to take several different medications at
various times and in different dosages may either become confused with the
schedule or ignore the instruction. If asked to change their daily medication
routine, a great deal of retraining may be needed to convince them of the
benefits of the new regimen (Kessels, 2003).
Non Compliance Behavior and Instructions By Nursing Educator
Another major factor in noncompliance is the lack of adequate and specific instructions about prescribed treatment regimens. Unfortunately, poor literacy skills are rarely assessed by healthcare personnel when, for example, teaching a patient about medications. Literacy problems tend to limit the patient's ability to understand the array of instructions regarding medication labels, dosage scheduling, adverse reactions, drug interactions, and complications (Davis et al., 2006; Elliot, 2007; Mauk, 2014; Williams et al., 2002; Wong, 2016).
No wonder those who lack the required vocabulary, organized
thinking skills, and ability to formulate questions, and who also receive
inadequate instruction, become confused and easily frustrated to the point of
taking medications incorrectly or refusing to take them at all.
Thus illiteracy, functional illiteracy, and low literacy
significantly affect both motivation and compliance levels. What is often
mistaken for noncompliance is, instead, the simple inability to comply.
Although almost half of the adult population is functionally illiterate, this
statistic is overlooked by many healthcare professionals as a major factor in
noncompliance with prescribed regimens, follow-up appointments, and measures to
prevent medical complications (Andrus & Roth, 2002; Doak et al ., 1996; Mc-Cray,
2005; Weiss, 2007; Williams et al., 2002).
A significant number of studies have correlated literacy levels
with noncompliance (Brown & Bussell, 2011; Doak et al., 1998; Jin. Sklar,
Min Sen Oh, & Chuen Li, 2008; Kalichman et al., 1999; Weiss, 2007) .
Individuals who have both poor literacy skills and inadequate language skills
often have difficulty following instructions and providing accurate and
complete health histories, which are vital to the delivery of good health care.
The burden of illiteracy leads patients into noncompliance not because they do
not want to comply but rather because they are unable to do so (Hayes, 2000;
Williams,
Counselman, & Caggiano, 1996). The impact of illiteracy is
broader than just the inability to read; it alters the way a person organizes,
interprets, analyses, and summarizes information (Giorgianni, 1998). Caregivers
often overestimate an individual's ability to under-stand instructions and are
quick to label someone as uncooperative and noncompliant. In reality. the
underlying problem may be limited cognitive processing that impedes
understanding and following written and oral communication.
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