Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success

摘要

Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behaviour fields. Given that the management of behaviour problems often requires substantial change in established client behaviour, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behaviour advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behaviour studies, and a survey instrument developed with items matched to these factors. 42 dog owners who had attended the University of Lincoln Animal Behaviour Clinic over a two year period, provided data used in the analysis. Assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to over-estimate success by half a point on a five point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument in any veterinary behaviour practice wishing to use client feedback to rationalise areas of the consultation which might be improved.