Article By: Maria Tucker, MPH, RDN, LDN, CDCES
Maria Tucker is a Registered Dietitian and Certified Diabetes Educator with over 20 years of experience assisting patients with diabetes, obesity, and nutrition-related conditions. Maria is also the Founder of MyBiyaya.com, a site dedicated to healthy recipes and kitchen shortcuts.
Adherence – The Oxford Language dictionary defines adherence as 1. Attachment or commitment to a person, cause, or belief OR 2. The quality or process of sticking to an object or surface.
Both definitions apply when it comes to taking care of one’s health. As health care providers, Registered Dietitians often make nutrition recommendations hoping that the patient will follow and adhere to the recommendations resulting in success. However, it is not always a given that patients will or can follow these recommendations. It can be frustrating both for patient and health care provider.
The Academy of Nutrition and Dietetics’ International and Nutrition Terminology (IDNT) Reference Manual, 4th Edition, provides a list of categories of nutrition diagnosis etiologies and contributing risk factors of the nutrition diagnosis. For example, denial of need to change is the etiology related to beliefs-attitudes which contributes to the nutrition diagnosis of not ready for diet/lifestyle change (NB- 1.3). There are several other examples of etiologies, including cultural, knowledge, psychological, social- personal which can affect adherence. Identifying which of these etiologies are contributing factors to non-adherence to recommendations is an important step in being able to assist patients in moving forward and achieving their health and nutrition goals.
Taking vitamin and mineral supplements is one aspect of nutrition care that patients can struggle with so here are some ways to increase your patients’ adherence with it:
1) Develop good rapport with your patient/client. Learn more about your patient – his/her typical daily schedule and lifestyle as well as who else may be involved in their health decision-making. Get to know the whole person! The more comfortable your patients are with you, the more they will trust with you and the more likely they are to follow and adhere to your recommendations.
2) Help the patient understand the why. When patients understand the reason behind the recommendations, they are more likely to follow them. For example, if the patient struggles with consistently taking their vitamin and mineral supplements after bariatric surgery, explain the risks of nutritional deficiencies post-surgery and the benefits of taking these supplements.
3) Assist the patient in identifying barriers – what keeps him/her from being able to follow recommendations. Include the support person in the nutrition session, if patient agrees, to help identify these barriers.
4) Have your patient verbalize a couple of strategies to overcome the barriers that they are willing and able to do. For example, if nausea keeps a patient from taking vitamins, suggest taking them after the last meal or snack at bedtime, but before brushing teeth. If forgetting to take vitamins is a concern, have the patient try setting an alarm for it. There are apps specifically made for setting reminders for taking medications; these apps can also be used for taking supplements.
5) Ask for your patient’s commitment to taking the supplements consistently. Set a date for when you expect the patient to have accomplished their goal. Encourage tracking progress - either on paper, such as a journal or diary, or via an app.
6) Follow up on your patient’s progress and offer praise if the goal was accomplished and encouragement if there is still some work to do to accomplish the goal.
Sticking to it, adherence, as in taking vitamins and minerals, isn’t’ rocket science, but as the definition of adherence states, is a process...a process which should be doable and needs commitment for it to work.