Date Presented 3/31/2017
Findings are presented from a longitudinal case history of a stroke survivor’s experiences during her 1st year of recovery. Specific findings related to the significance of “going against” medical advice to her process of recovery are highlighted. Compliance as an occupational therapy concept is questioned.
Primary Author and Speaker: Julie McLaughlin Gray
PURPOSE: A longitudinal case history of an individual stroke survivor informs this presentation on potential ways in which a noncompliant stance might be useful to the process of healing and recovery from a catastrophic illness. Since its introduction by Haynes and Sackett (1979), the concept of compliance in health care has been the subject of a great deal of research and critique. Recently, the discourse on compliance and adherence has shifted toward a more complete reconceptualization, one that acknowledges the complex interactions through which health care professionals and clients must collaborate and holds that behaviors linked to maintaining one’s health are intricately tied to a contextual process involving the negotiation of a variety of influences. This work suggests exciting possibilities for occupational therapy and occupational science contributions to understanding and promoting health behaviors among individuals and communities. This presentation also offers an alternate perspective on noncompliance: the contrasting view that there may be times when noncompliance is actually beneficial.
DESIGN AND METHOD: This paper presents findings from a longitudinal case study with Sara, a woman recovering from a stroke. This longitudinal case history used narrative to provide a way for the researcher and clinicians to better understand the lived experiences of an individual participating in rehabilitation and the complexity surrounding functional and occupational transitions in stroke recovery. The researcher interviewed the stroke survivor, along with friends and family members, caregivers, and the entire rehabilitation team. The stroke survivor was followed, via regular interviews and participant observation, in the natural context—hospital, home, and community—for the 1st year of recovery.
RESULTS AND CONCLUSION: Sara’s experiences highlight possible ways in which a tendency to “go against”—what some might consider noncompliance or even recalcitrance—can be an asset in the complex and formidable process of reconstructing life and self with a new body and a new mind. In support of this idea, the paper offers stories of significant turning points in Sara’s occupations or recovery that seemed tied to a recalcitrant stance and discusses the apparent advantages of Sara’s unwillingness to comply with medical authority.
References
Haynes, R. B., & Sackett, D. L. (1979). Compliance in health care. Baltimore: Johns Hopkins University Press.
Lerner, B. H. (1997). From careless consumptives to recalcitrant patients: The historical construction of noncompliance. Social Science and Medicine, 45, 1423–1431. https://doi.org/10.1016/S0277-9536(97)00067-1
Lutfey, K. E., & Wishner, W. J. (1999). Beyond “compliance” is “adherence”: Improving the prospect of diabetes care. Diabetes Care, 22, 635–639. https://doi.org/10.2337/diacare.22.4.635
Marinker, M.; Royal Pharmaceutical Society of Great Britain. (1997). From compliance to concordance: Achieving shared goals in medicine taking. Report of the Working Party. London: Royal Pharmaceutical Society of Great Britain & Merck Sharp and Dohme.
Mykhalovskiy, E., Mccoy, L., & Bresalier, M. (2004). Compliance/adherence, HIV, and the critique of medical power. Social Theory and Health, 2, 315–340. https://doi.org/10.1057/palgrave.sth.8700037
Wiles, R., Ashburn, A., Payne, S., & Murphy, C. (2004). Discharge from physiotherapy following stroke: The management of disappointment. Social Science and Medicine, 59, 1263–1273. https://doi.org/10.1016/j.socscimed.2003.12.022
