Compliance in Context: An Exploratory Study of Chronic Obstructive Pulmonary Disease From the Interactional Perspective
Thomas, Barbara Lyn
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https://hdl.handle.net/2142/69202
Description
Title
Compliance in Context: An Exploratory Study of Chronic Obstructive Pulmonary Disease From the Interactional Perspective
Author(s)
Thomas, Barbara Lyn
Issue Date
1988
Department of Study
Education
Discipline
Education
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
Health Sciences, Medicine and Surgery
Psychology, Clinical
Abstract
Approximately half of all chronic medical patients do not adhere to their physicians' advice, a phenomenon that is poorly understood even after hundreds of empirical compliance studies. A qualitative research method offers the potential to identify more productive avenues of investigation. This study employed a combination of participant observation, interviewing, and documents in the form of pulmonary medical records.
Chronic obstructive pulmonary disease (COPD) is a prevalent lung condition that entails a complex medical regimen, and the compliance behavior of COPD patients is understudied. There are indications that interpersonal relationships influence the compliance behavior of COPD patients, and the interactional theory of the Mental Research Institute in Palo Alto, California was utilized to investigate the nature of this influence.
Four COPD patients, ranging from an extremely noncompliant patient to a model complier, were studied in the social contexts of family life, vocational life, and relationships with health care providers. Three compliance-related interactional patterns occurred across cases and across social subsystems. Because all four subjects were patients of a single pulmonary physician, interviews with the doctor provided a limited case study of the manner in which physicians perceive their patients' compliance behavior.
The study's results also included descriptive information about COPD and compliance, from the patients' perspective. The most salient feature of living with COPD consists of a combination of elements: its effects are pervasive and powerful, yet subtle. Patients sort medical advice in terms of the amount and type of influence it has on their pre-existing lifestyle. Patients exhibit consistent compliance patterns for specific parts of a complex regimen, but any given patient may have several different compliance patterns which correspond to various parts of a total regimen.
This study has demonstrated that it is unnecessary to develop separate theoretical concepts for different facets of compliance, since the pertinent interactional patterns between patients and their close associates are not limited to a specific social context. Further research, combining qualitative method and interactional theory, should verify the interpersonal patterns found in this study, develop a more complete inventory of such patterns, and investigate various combinations of them.
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