The health belief model and factors associated with adherence to treatment recommendations for positional plagiocephaly

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>This study aimed to examine factors associated with adherence to recommended treatment among pediatric patients with positional skull deformity by reviewing a single-institution experience (2007–2014) with the treatment of positional plagiocephaly.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective chart review was conducted. Risk factors, treatment for positional head shape deformity, and parent-reported adherence were recorded. Univariate and multivariate analyses were used to assess the impact of patient clinical and demographic characteristics on adherence.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 991 patients under age 12 months were evaluated for positional skull deformity at the Texas Children's Hospital Cranial Deformity Clinic between 2007 and 2014. According to an age- and risk factor–based treatment algorithm, patients were recommended for repositioning, physical therapy, or cranial orthosis therapy or crossover from repositioning/physical therapy into cranial orthosis therapy. The patients' average chronological age at presentation was 6.2 months; 69.3% were male. The majority were white (40.7%) or Hispanic (32.6%); 38.7% had commercial insurance and 37.9% had Medicaid. The most common initial recommended treatment was repositioning or physical therapy; 85.7% of patients were adherent to the initial recommended treatment.</jats:p> <jats:p>Univariate analysis showed differences in adherence rates among subgroups. Children's families with Medicaid were less likely to be adherent to treatment recommendations (adherence rate, 80.2%). Families with commercial insurance were more likely to be adherent to the recommended treatment (89.6%). Multivariate logistic regression confirmed that factors associated with parent-reported adherence to recommended treatment included primary insurance payer, diagnosis (plagiocephaly vs brachycephaly), and the nature of the recommended treatment. Families were less likely to be adherent if they had Medicaid, a child with a diagnosis of brachycephaly, or were initially recommended for cranial orthosis therapy than families with commercial insurance, a child with a diagnosis of plagiocephaly, or an initial recommendation for repositioning or physical therapy.</jats:p> <jats:p>Factors associated with treatment completion included corrected age, insurance, diagnosis, recommended treatment, and distance to provider from patient's residence. Patients with commercial insurance (OR 1.49, 95% CI 1.10–2.02, p = 0.009), those diagnosed with both brachycephaly and plagiocephaly (OR 2.26, 95% CI 1.31–3.90, p = 0.003), those recommended for treatment with cranial orthosis (OR 4.55, 95% CI = 3.24–6.38, p &lt; 0.001), and those living in proximity to the provider (OR 1.40, 95% CI 1.00–1.96, p = 0.047) were more likely to complete treatment.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Insurance type, degree of head shape deformity, and types of recommended treatment appear to affect rates of adherence to recommended treatments for positional skull deformation.</jats:p></jats:sec>

Practical Review of the Cost of Diagnosis and Management of Positional Plagiocephaly

“…11,37 One study by Lam et al analyzed the degree of treatment compliance according to patient subgroups and found that families with public insurance were less likely to adhere to the recommended treatment than families with private insurance (80.2% versus 89.6%). 38 The authors do not discuss the cause, but one possibility is a lack of coverage for required follow-ups. The consensus is that coverage for low-income Americans is insufficient to support multivisit treatment plans, which considerably affects treatment accessibility and can lead to the development of more severe deformities in low-income households.…”

The structure of the Risk Culture Framework: Evidence from a health context

“…The RCF was then applied to the subject of health. Identification of central health risks and aspects are based on reports (e.g., from WHO), health-related theories and models including the Health Belief Model (Hochbaum, 1958;Lam et al, 2017) and health-related beliefs (e.g., Robertson, 2006). Frameworks within risk culture (e.g., Treating Customers Fairly;Financial Services Authority, 2007;and the Culture Framework;McConnell, 2013) and health (the Gateway Model; Kipping et al, 2012) were also considered.…”