People behave in a similar
way to others who are like them, and have influenced them.
Martin, S. (2008). The science of compliance. Practice
Nurse, 35(1), 38-39.
People are more obliged to do for others what they have done
Martin, S. (2008). The science of compliance: reciprocity.
Practice Nurse, 35(3), 37.
People act in line with previous commitment, even if demands
Martin, S. (2008). The science of compliance: consistency.
Practice Nurse, 35(5), 43.
People are more likely to follow those with expertise and
credibility to guide their decisions. Instead of displaying "power",
compliance will happen when you display "expertise and credibility"
Martin, S. (2008). The science of compliance: authority.
Practice Nurse, 35(7), 39.
People are influenced more by those whom they like and who
Martin, S. (2008). The science of compliance: liking. Practice
Nurse, 35 (9), 43.
Opportunities that appear more valuable when they appear less
available. Focus on what the client/patient stand to lose if
they 'do not' without instilling fear in the patient.
Martin, S. (2008). The science of compliance: scarcity.
Practice Nurse, 36, 50.
People who do not exercise or exercise sporadically perceives
more barriers to exercise than those who exercise regularly.
Also, people who exercise regularly rate their confidence higher
(i.e., self-efficacy) to overcome obstacles to exercise.
Simonavice, E.M., Wiggins, M. S. (2008). Exercise barriers,
Self-efficacy, and stages of change. Perceptual and Motor Skills,
107, 3, 946.
Perceptions of self-efficacy have been consistently identified
as being determinants of exercise adherence in asymptomatic,
rehabilitative, younger, and older populations.
McAuley, E. Courneya, K.S. Rudolph, D.L. Cox, C.L. (1994).
Enhancing exercise adherence in middle-aged males and females.
Preventive Medicine, 23, 498-506.
Exercise intensity is posited to influence affective response
to exercise via interoceptive and cognitive pathways. People
who pace themselves during an exercise prescription adhere to
the exercise prescription at a higher rate as compared to those
who pushed at higher pace than a comfort zone.
Williams, D.M. (2008). Exercise, Affect, and Adherence:
An integrated model and a case for self-paced exercise. Journal
of Sport and Exercise Psychology, 30, 5, 471.
Apparently unhealthy individuals (smokers, cardiovascular
high risk patients, overweight patients) should be informed of
the benefits of exercising at a moderate intense, a lower intensity
that is generally perceived to be necessary by this population.
Gordon, N.F. et al. (1993). Life style exercise: A new
strategy to promote physical activity for adults. Journal of
Cardiopulmonary Rehabilitation, 13, 3, 161-163.
Client Centered Approach
A client-centered approach is the most important component
of a health coaching skill set. Patients can ascertain whether
you are truly attempting to understand their situation instead
of merely trying to manipulate them into change. Respecting each
patient's autonomy, drawing out ambivalence about change, evoking
change talk, and allowing the patient to develop and/or own the
treatment plan greatly improve the chances of achieving positive
Butterworth, S.W. (2008). Influencing patient adherence
to treatment guidelines. Journal of Management Care Pharmacy,
14, 6, 21-24.
Example Client Centered Goal
Setting and Sample Interaction
with Athlete. Also see Anchoring.
The efficacy of the Physiotherapy treatment plan is highly
dependent upon patient compliance. Only 34 to 62% of patients
undergoing physiotherapy correctly apply their exercise programs.
Three main factors related to noncompliance:
- Barriers patients perceive and encounter
- Lack of positive feedback
- Degree of helplessness
There was no difference between men and women with regard
to patient compliance, but less educated patients were slightly
more compliant than more highly educated patients (Sliijs EM,
Sluijs EM, Kok GJ, van der Zee J (1993). Correlates of
exercise compliance in physical therapy. Physical Therapy; 73
Interventions to enhance family support were effective in
some cases, but belief in the benefit of the recommendation was
the critical variable in all types of compliance.
Ferguson K, Bole G (1979). Family support, health beliefs,
and therapeutic compliance in patients with rheumatoid arthritis.
Patient Counseling and Health Education; 1(3), 101-105.
Client compliance rose significantly (77.4% vs 38.1% compliance)
when take-home explanatory text and diagrams were provided in
addition to verbal exercise programs instruction alone.
Schneiders AG, Zusman M, Singer KP (1998). Exercise therapy
compliance in acute low back pain patients. Manual Therapy, 1998;
Deyo R A. (1982). Compliance with therapeutic regimens
in arthritis: issues, current status, and a future agenda. Seminars
in Arthritis and Rheumatism; 12(2), 233-244.
Patients that viewed a video demonstration of exercises reproduced
them more easily than those who viewed static images. Video modeling
was indicated as more appropriate for encouraging confidence
and motivation in an unsupervised exercise environment, such
as a home exercise program.
Weeks DL, et. al. (2002) Videotape instruction versus illustrations
for influencing quality of performance, motivation, and confidence
to perform simple and complex exercises in healthy subjects.
Physiotherapy Theory and Practice, 18 (2), 65-73.