Pressure garment adherence in adult patients with burn injuries: An analysis of patient and clinician perceptions

Objective. This study provides a descriptive analysis of the factors affecting pressure garment adherence from the perspective of adult patients with burn injuries and occupational therapy clinicians. Method. Questionnaires were administered to 23 adult patients with burn injuries and 10 occupational therapy clinicians selected from six provincial hospitals in a large metropolitan area in South Africa. Adherence behavior was evaluated from the perspective of both sample groups in terms of four variables: garment type, garment comfort, garment cosmesis, and garment instructions. Results. Adherence behavior was negatively influenced by differences in both patient and clinician perceptions across several variables, including the types and consequences of skin problems arising from pressure garment use, levels of satisfaction with garment construction and color, and the issuing and understanding of garment instructions. Other factors compromising adherence behavior included the negative effects of visible burn disfigurement, the issuing of pressure garments after hypertrophic scarring had developed, a lack of patient choice in the selection of scar management techniques, and a lack of social support in the wearing of pressure garments. Conclusion. Much of what is traditionally understood as "patient nonadherence" appeared to be largely because of rational choices made by patients in the face of several difficulties they experienced with the current form and nature of their pressure garment therapy. On the basis of these findings, a range of patient-centered interventions are indicated to enhance treatment efficacy and consumer satisfaction with this treatment regimen, including horizontal rather than vertical therapist-patient communication, closer interaction among members of the health care team, the facilitation of family and social support, and interactive health education interventions.