The aim of this essay is to consider the psychological factor of social influence could be contributing to the current situation of an 8 year old girl who is suffering with asthma, she lives with her Mum in the area of Springburn in Glasgow, and after a recent review has presented some issues that have raised concern.

Conformity, compliance and adherence are all forms of social influence and these can occur when a person’s behaviour and emotions are being affected by other people, or groups of social classes. In some circumstances social influence can be direct in the shape of advertising and media, which are good examples of channels that can influence attitudes and behaviours. In other situations social influence can be very subtle and indirect, that is of family, partners, friends, classmates, celebrities and so on, and the fashion in which information is presented, can often determine the degree of compliance. Thus the term social influence can refer to the way in which other people’s conduct is influenced by the presence and action of others. When referring to a patient’s compliance the terms ‘adherence’ and ‘compliance’ are used interchangeably (Psychology for Nurses, 2009, p. 432). Compliance was commonly used during early stages of research, and it investigated whether a patient followed their medical regime. Hayes et al. (1979) defined compliance as, ‘The extent to which the patient’s behaviour (in terms of medication, following diets or other lifestyle changes) coincides with medical and health advice’,
Philip Ley (1981, 1989) developed the cognitive hypothesis model of compliance, and according to this model, patient compliance can be predicted by; patient’s satisfaction with the process of the consultation; understanding of the information provided during the consultation; and the recall of this information. Numerous studies have highlighted the important role patient satisfaction has to play in influencing patient’s adherence to medication and medical advice. Wolf et al. (1978) conducted a study which measured specific parts of a consultation, to determine what actually resulted in patient satisfaction, on conclusion Wolf and his colleagues stated that three parts of the consultation were perceived by patients to have been detrimental in influencing patient satisfaction: (a) the cognitive aspect – satisfaction with the amount and quality of information provided by the health care professional; (b) the affective aspect – the extent to which the patient feels that the health care professional listened, understood and was interested; and (c) the behavioural aspect – the patients evaluation of the healthcare professionals competence in the consultation.
Other studies have looked at the frequency of paediatric non-adherence across a range of illnesses. They found that adherence levels were at or below fifty per cent of prescribed dosages are common. (Rapoff, 1999). Poor adherence rates have been commonly highlighted as a particular problem for children with asthma (Coutts et al., 1992)
According to the National Asthma Council (2003) adherence can be defined as ‘A term that focuses more on the patient’s commitment to regime. It is based on responsible negotiations and more patient empowerment than compliance’.
In this case, the contributing factors that maybe influencing her current behaviours, while taking into account social influences; could be that she is feeling embarrassed within her peer group, as her classmates are laughing at her, resulting in her feeling different and uncomfortable within her peers, her desire to fit in and not appear different, could be leading to her neglecting her medication regime. Furthermore, the circumstances at home that may be contributing to her situation, could be due to the fact that her Mother is currently unemployed and therefore finding it difficult to provide basic needs for her; there could be a lack of heating in the which would also have a detrimental effect on her Asthma; having a balanced diet is also important and very beneficial to Asthma sufferers, but due to a lack of income, her Mother maybe finding it difficult to afford healthy foods. Research suggests that poorer children are exposed to higher levels of family turmoil, violence, instability and chaotic household conditions; which therefore results in them experiencing less support, which could be connected to the reason why this young girl is experiencing conflict and stress between her Mother and Grandmother.

It is also important to consider the psychological factor of communication, and how this may be helping or preventing her from improving her current situation. Effective communication plays a key role in good health and therefore important to adherence. Between the age of 7 and 12 a concrete operational stage is reached (Piaget, 1980), therefore this young girl should be able to think logically and organise her thoughts coherently, which would suggest that she has the communication skills to understand her illness along with the biological causes, she should also have the ability to recognise the impact that non-adherence to her medication regime will have an effect on her illness. However, there may be some significance to the fact that her classmates are making fun of her, which could be affecting her emotional state as she feels embarrassed, and therefore her emotions could be acting as a barrier to communication, resulting in her misunderstanding the importance of her medication.

Having considered all the relevant factors related to this case, and as a child and young person’s nurse to be able to provide effective management of her condition, adopting a cognitive model of compliance would be considered. This model suggests that the communication process between nurse and patient can be an influence to adherence. It also proposes there are three factors that may affect adherence which are; patient satisfaction with the process; understanding the information provided during a consultation; and the recall of this information. To be able to perform this effectively the information should be simple and at her cognitive level; the most important information and instructions should be given at the beginning of the process; while all the time ensuring she is listening. By doing this and confirming the young girl and her mother fully understand what they are being asked to do: better knowledge and understanding will equate to better adherence.

In summary this essay has demonstrated the many factors that may be contributing to the adherence of this young girl. It has shown how such factors could determine her decision to adhere or not, which range from confusion, communication and social factors. It also supports the fact that a nurse who is familiar with how these factors can contribute to adherence can address such factors, thus increasing the likelihood that the patient will adhere correctly when advice, instruction and information have been given.

Word Count: 1092

References

Coutts, J.A.P., Gibson, N.A and Paton, J.Y. (1992) Measuring compliance with inhaled medication in asthma. Archives of Disease in Childhood, 67, 332-333
Haynes, R.B. (1970) Detriments of compliance: the disease and the mechanics of treatment. In: Compliance in Health Care (Eds R.B Haynes, D.W. Tayor and D.L. Sakett). John Hopkins University Press, Baltimore, MD.
Ley, P. (1981) Professional non-compliance: a neglected problem. British Journal of Social and Clinical Psychology, 20: 151-154
National Asthma Council (2003) Asthma Adherence; A Guide for Health Professionals. Australia [Online] (http://wwwnationalasthma.org.au/publications)
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