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

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.

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.

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).

The very concept of prevention entails features that jeopardize the efficiency of educational programmes used for its implementation.

(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.