Compliance with treatment protocols: interventions for children with chronic illness

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Abstract
The delivery of health care is, in part, dependent on the willingness and motivation of patients to follow the regimens prescribed. No matter how effective treatments are, if children and parents do not follow instructions adequately, then health care is compromised. During the past 20 years the medical literature has been concerned with the issue of compliance, however, the current debate on evidence-based practice has, so far, failed to address this important dimension. To date, little account has been taken of methods to improve compliance within medical protocols of treatment. Many childhood chronic conditions such as asthma, diabetes, cystic fibrosis, and chronic renal disease require complex management regimens of medications to be taken daily as well as dietary or activity demands or restrictions. In addition, some children may have to undergo painful or demanding medical procedures. Treatment regimens may also bring with them major life disruptions such as attendance at clinics, frequent hospitalisations or treatment sessions, which cause absences from school. Some parents may have to give up work to deal with treatment demands. Families are responsible for following treatment protocols while dealing with the stresses and demands of the disease process.1 The literature has consistently documented a link between regimen complexity and compliance. The rates of non-adherence cited for some conditions show that compliance problems are so frequent that they could be considered to be a normal response to the demands of illness and treatment. For example, when adherence rates to antibiotic regimens among bone marrow transplant patients were examined it was found that 52% of patients had problems.2 Similar rates of non-adherence were found for multivitamin use in cystic fibrosis patients.3 The high rates of non-adherence among asthma patients have been described as a “cost problem” because of the increased rates of hospitalisation that are …