Obstacles to patient education in chronic diseases: a trans-theoretical analysis.

Abstract

OBJECTIVE: The aim of this article is to discuss the background and the consequences of preference on short-term rewards by individuals, which represents an obstacle to any educational programme aimed to prevent long-term complications of chronic diseases such as diabetes, hypertension or obesity. METHODS: We used a trans-theoretical analysis referring to three theories: (1) Construal Level Theory (Trope and Liberman) suggests that the human mind tends to assign remote events as "high-level" criteria, abstraction, in particular, and to proximal events as "low-level" criteria, a concrete description, in particular. (2) Intertemporal Choice Theory (Ainslie) explains why people often prefer short-term small rewards over long-term large rewards. (3) The theory developed by Parfit suggests that the personal identity of human beings is made of a succession of multiple individuals, in time, who find their identity by the fact that there is a connectedness between them. Since this connectedness is weaker for prolonged periods of time, this Personal Identity Theory may explain why we may be less interested in our future. RESULTS: In the minds of people who are supposed to benefit from such programmes, there may be a striking contrast between the objectives of preventive medicine (typically a high-level construal), which represents an abstract and long-term concept (e.g. "to avoid complications"), and that of the representation of inaction, a low-level construal which is by contrast immediate and concrete and can be readily imagined (e.g. a nap in front of the TV set). CONCLUSION: The very concept of prevention entails features that jeopardize the efficiency of educational programmes used for its implementation. PRACTICE IMPLICATIONS: (1) In chronic diseases, designing programmes proposing concrete and short-term preventive measures may represent a way to overcome this obstacle. (2) Habit may be used to reinforce connectedness which forms personal identity. (3) Thus, taking into account this temporal dimension of educational programmes is essential.