The place and role of compliance in the treatment process, in the perception of university students in rostov-on-don

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Introduction. Currently, modern medicine uses an integrated approach in the treatment of the disease, taking into account not only the medical model of the disease based on a biological deviation from standard or normal functioning, but also the biopsychosocial model of the disease, which also includes social and psychological elements. The successful outcome of treatment depends on many components, and compliance plays an important role in this process.The problem of low compliance, self-medication, and the use of questionable treatment methods includes all the factors of the treatment process: prevention, positive outcome, and maintenance of public health of the population as a whole. According to the WHO definition of compliance-"the degree of compliance of a patient's behavior with regard to the use of medication, the implementation of dietary recommendations or lifestyle changes, the appointment and indication of a doctor" [1] Determining the factors influencing the level of compliance, the World Health Organization identifies 5 groups: [4]Social factors, including material, cultural, educational, age, gender, etc. aspects Systemic factors related to healthcare and its capabilities, with the purchase of medicines taking into account the models of doctor-patient relationsThe factors associated with the disease take into account the degree of complexity of the symptoms, the stage of the disease and its dynamics, polymorbid conditions in patients, and the existence of effective therapy.  The factors due to therapy take into account the duration of treatment, the complexity associated with polypragmasia during treatment, etc.Factors due to the personal characteristics of the patient, phobias of various types, low level of responsibility, in relation to timely fulfillment of obligations during treatment, high expectations regarding the results.The study of studies devoted to the analysis of this problem has revealed different approaches to compliance. For example, Volskaya E.A. believes that in studies of this phenomenon and consideration of the patient's obligations, it is important to pay attention to the characteristic mental features that form a system of views and stereotypes (including behavioral stereotypes) of people characteristic of certain ethnic, religious, and professional communities [2].In a number of studies (Shamov I.A., Asriyan O. B., Kadyrova R. V., Kovalchuk S. A.) close cooperation between the doctor and the patient is considered as the most important condition for increasing the level of compliance.A representative of the psychological direction Mendelevich V.D., defines three functional blocks in the compliance structure:a sensory-emotional block based on a subjective-emotional assessment of the treatment process; a logical block that forms a system of impartial assessments and explanations of the obligation of treatment and its consequences; a behavioral block based on a motivational system and aimed at implementing a therapeutic program. According to the author, a significant role in the compliant behavior and its level (degree) is played by the mental and personal properties of the patient. [3]According to research data in Russia, only 13% of the country's population visits a doctor regularly, and 40% apply in extreme cases (the global average is 66%). The reason is that trust in medicine is not high enough: only 25% of Russians trust the experience and qualifications of doctors, 60% of the population consider the patient's properties of doctors only as consultants [5]. The incompetent behavior of patients leads to an increase in the medical and social burden of diseases and an increase in government spending on healthcare. The study of the sources showed that there are not enough works investigating the perception of the problem of compliance among university students[5].The purpose of this study is to study the level of awareness and understanding of respondents about the place and role of compliance in the treatment process, their behavioral model and to determine the degree of compliance of study participants in correlation with the profile of education. We assume that the level of awareness and perception of respondents about "compliance" and the degree of their adherence to treatment is causally dependent on the educational profile of the survey participants.Materials and methods of research. The study included 2 stages (05.2023-02.2024): Stage 1-(05-11.2023)-study and secondary analysis of scientific sources, development of research tools and conducting a pilot study; stage 2-(09.2023-02.2024)-conducting an empirical study.  The sample was selected by the method of typical representatives, the inclusion criterion is students of Rostov-on-Don and consists of 723 respondents. 1st gr.-340-students of RostSMU, 2nd gr.-383-students of non-medical universities of Rostov-on-Don (SFU, DSTU..). The systematization of the data obtained and the assessment of the reliability of statistical analysis were carried out using the Microsoft Excel program.In the analysis of the data obtained, a comparison method was used, the Statistical criterion of the reliability of differences, the T-Student criterion.The main tool of empirical research was a questionnaire with a composition corresponding to the principle of validity. The questionnaire includes 4 blocks of questions: passport; a block of questions aimed at identifying the level of awareness of respondents about compliance and determining the place and role of compliance in the treatment process; a block of questions reflecting the degree of compliance of respondents based on the quantitative scale of adherence to compliance according to Morisky-Green-Levine and a block of questions aimed at determining the effectiveness of measures that increase the degree of compliance.The results of the study. The essence of the definition of "compliance" is correctly understood – 89.6% of the 1st gr. and 78% of the participants of the 2nd gr. Determining the place and role of compliance in the treatment process 76% of 1st gr. 54% of the 2nd group believe that compliance increases the effectiveness of treatment and improves treatment outcomes. The main factor influencing the degree of compliance, a significant part of the survey participants in both groups cites the level of public awareness of the importance of following the recommendations and prescriptions of a doctor: 79.6%-1 gr., 67.9%-2 gr. The majority of the surveyed students, regardless of their education profile (59.7% - 1st grade and 64.8% - 2nd grade)  They note the need for a high level of compliance to maintain a high level of therapy effectiveness. The level of compliance, according to 79% of 1-gr. and 57.8% of 2-gr., equally depends on the doctor and the patient. Assessing the importance of compliance in the treatment process on a 3-point scale, 88%-1g and 76%-2 gy gave the maximum assessment of the importance of compliance. The determination of the level of compliance of the survey participants using the clinical and psychological test method - the Morisky–Green -Levine scale, showed that the majority of representatives of the 1st group (78%) have insufficient adherence to treatment, the 2nd group (81%) showed non-adherence to treatment. The majority of the surveyed students in both groups, 90% - 1 gy and 78.3%-2 gy, consider raising public awareness of the importance of following the recommendations and prescriptions of a doctor as the most effective measures to increase the level of compliance.Conclusion. The hypothesis has been partially confirmed. The education profile has a minor impact on the level of awareness and understanding of respondents about the essence, place and role of compliance in the treatment process, but in determining the degree of their adherence to treatment, it shows a difference in behavioral models depending on their education profile.

About the authors

Laura Samvelovna Djalalyan

Rostov State Medical University

Author for correspondence.
Email: lauradjalalyan@gmail.com
ORCID iD: 0009-0004-8534-5282
Russian Federation, 344022, Russia, Rostov-on-Don, lane Nakhichevan 29

Karina Borisovna Mkrtycheva

Rostov State Medical University

Email: kasya--21@mail.ru
ORCID iD: 0009-0000-8583-2524

PhD, Associate Professor of the Department of Economic and Social Theory

Russian Federation, 344022, Russia, Rostov-on-Don, lane Nakhichevan 29

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