A Simple, Psychologist-Backed Strategy for Better Patient Adherence

Like it or not, psychology is a rather large part of physiotherapy.

No matter what area you work in, you’re constantly navigating psychology. You’re deciding how to explain something so it actually lands, trying to understand how a patient’s past experiences might be influencing their pain, and perhaps most frustratingly of all… wondering why they still aren’t doing the exercises you so thoughtfully prescribed.

The reality is that improving adherence often requires behaviour change. That’s exactly what expert psychologist Dr Serena Simmons explores in her Behaviour Change in Clinical Practice Masterclass. One concept, in particular, stands out as fundamental to helping patients engage with treatment: finding their “why.”

Want an in-depth understanding of psychology for physios? Watch Serena’s full Masterclass here.

What is a patient’s “why” and why does it matter?

A patient’s “why” is their reason for engaging with treatment. It’s the purpose that makes the hard work feel worth it.

Most physios are good at identifying goals during the subjective assessment, but Serena highlights an important distinction between two different types of “why.” The macro “why” is the bigger-picture purpose. It reflects what really matters to the patient, such as being an active grandparent who can run around the park with their grandchildren. The micro “why” consists of the shorter-term milestones that move them towards that bigger goal.

The challenge is that patients rarely arrive with a clearly defined “why.” Teasing it out is often a collaborative process. Taking the time to figure it out early is useful, because behaviour change is uncomfortable. Without a purpose that the patient genuinely cares about, there’s little perceived benefit to persisting with something that’s difficult. So helping patients connect with a meaningful reason for engaging in your treatment plan is an integral step in promoting adherence.

What makes change so hard?

It can be frustrating when patients don’t follow the treatment plan you’ve spent time developing. But in most cases, it isn’t because they simply can’t be bothered. Behaviour change is more complex than that – change is uncomfortable. People naturally resist stepping outside their comfort zone unless staying where they are becomes even more uncomfortable.

Think about smoking. Most smokers already know the health risks, yet many continue smoking despite that knowledge. Information alone rarely drives change. Instead, change often occurs when the consequences of current behaviour become significant enough to outweigh the discomfort of doing something different.

Physiotherapy is no different. Knowing that physiotherapy may help their condition, albeit an important first step, is not necessarily going to facilitate engagement. Starting an exercise program may conflict with how someone sees themselves. They may identify as someone who “isn’t sporty,” “doesn’t exercise,” or even someone who has “a bad knee.” Surprisingly, the very condition they’re seeking treatment for can become part of their identity, making change even harder.

Recognising the patients who are ready for change, or are at least feeling ambivalent, is an important clinical skill.

Identifying a patient’s “why”

The first subjective assessment is the ideal place to begin exploring their “why”. It’s more than just “I don’t want to be in pain anymore.” You want to dig deeper to understand what they would be able to do differently if the problem wasn’t there.

Watch Serena explain how to do this in this clip from her Masterclass:

Sustaining the patient’s “why”

Helping patients engage initially is only half the challenge, maintaining that engagement is just as important.

Our job is pretty challenging – unlike many healthcare professionals who prescribe a treatment and review the outcome months later, physiotherapists often need to maintain engagement and motivation week after week.

Fortunately, this is something we’re already well equipped to do; clear goal setting, regular progress reviews and objective measures all help reinforce that patients are moving towards what matters most to them. Continually linking treatment back to their macro and micro “why” reminds them why they’re putting in the effort.

Additionally, it’s important to consider how the environment we create for patients shapes their thinking, which in turn influences how they feel. Watch this clip from Serena’s Masterclass, where she demonstrates this concept through an interesting experiment:

Wrapping up

Psychology is woven throughout physio practice. While we’re not psychologists, understanding key behaviour change principles can make us better communicators, help us understand our patients more deeply and ultimately improve engagement with treatment.

If you want an in-depth understanding of psychology for physio practice, watch Dr Serena Simmons’ full Masterclass here.