Activity lists and self-monitoring may be two strategies to encourage compliance to a health regimen. So found this study of heart patients done at the Gerontology Research Center in Baltimore that may prove useful at high risk for self injurious behavior.

Nine men who recently had a myocardial infarction (popularly called a "heart attack") were judged to be non-compliant; that is, they weren't going to follow the recommended recovery program. Ways to judge non-compliance, thought researchers Walter Baile and Bernard Engel, were previous history of noncompliance, expressed unrealistic expectations of work ability, unwillingness to slow down, serious non-compliance in the hospital's intensive care unit, denial of heart injury, and delay in seeking treatment.

Each went through a three-step program. First, they were evaluated. Next, they were introduced to the program. Here, they ranked a list of daily activities by severity of exertion and were taught to gauge their heart rate while doing the activities and watch for symptoms such as shortness of breath, fatigue, or chest pain. Most started the program in the hospital.

In the third stage of the program, patients came in once a week for half an hour to have their pulse taken and for symptom monitoring.

Two patients refused to participate. One returned to the hospital a year later with heart failure. Three patients were reluctant to participate because they thought their condition wasn't serious. Their reluctance faded.

The seven were highly compliant as judged by the facts that all remained in the study and each kept extensive records. Also, they took their pulse rates before and after their listed activities and kept their physician appointments.

There was almost no realization that a myocardial infarction results in tissue death and that a minimal period of relative quiet was necessary to permit the formation of scar tissue and prevent extension. The essential part of the program was the weekly visits.

Willingness of patients to comply may be because the program returned control to the patient. The task-oriented program, too, kept patients active. There was also frequent positive reinforcement that showed progression and encouragement at the weekly visits. It helped, too, that the regimen was individualized.

EndNotes

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Baile, W. F., & Engle, B. (1978, August). A behavioral strategy for promoting treatment compliance following myocardial infarction. Psychosomatic Medicine 40(5), 413-419.