Manipulation of patient-provider interaction: discussing illness representations or action plans concerning adherence

According to Leventhal’s Self-Regulatory Model of Illness, patients have ideas and action plans related to the management of their disease. The aim of this study is to examine whether ideas and action plans relating to hypertension change as a result of general practitioner’s (GP’s) discussing them during consultation, and whether these changed ideas and actions plans affect adherence. The study employed an experimental design, highlighting three conditions: (0) care-as-usual consultation; (1) discussing patient’s ideas about their disorder; and (2) discussing patient’s action plans. Ten GP-trainees performed care-as-usual consultations, were subsequently assigned to a training in either Condition 1 or 2, and performed the trained conversations. Hundred and eight patients with hypertension were consecutively assigned to the conditions, and completed questionnaires a week before, immediately after the consultation, and 1 month later. The training resulted in two new, feasible and different types of conversations that managed to affect some of the patient’s ideas and action plans. It is concluded that the study provided GPs with a tool to discuss illness representations and actions plan of patients with hypertension. Implications for the management of hypertension adherence in primary care are discussed.