Improving Client Engagement to Treatment: Researching the Connection between Service Satisfaction and Treatment Engagement from the Client's Perspective

Background and Purpose:

A collaborative process between the client and clinician strengthens not only the assessment, but also supports a client’s engagement with the treatment recommendations and maintenance of treatment protocols. While these factors alone do not guarantee adherence, a client’s motivation to engage with and their ability to remain committed to treatment, may deteriorate and subsequently falter if a client is not satisfied with the treatment or clinician. These satisfaction barriers to engagement are more problematic for underserved populations, who already experience significant challenges to receiving and maintaining adequate and appropriate health care. For social work clinicians and researchers, understanding the needs of diverse communities with respect to health care satisfaction may strengthen treatment engagement for these vulnerable clients.  Accordingly, social work researchers and practitioners need to be aware of what clients want from their health and mental health provider relationship, and be able to identify effective means to assess and evaluate client satisfaction in relation to treatment engagement. Thus, the aims of this research are: 1) to identify the predictors or barriers to client satisfaction; 2) to identify the predictors or barriers affecting engagement and treatment adherence; and 3) to examine the interaction of client satisfaction and treatment engagement.    

Methods:

This presentation will draw from the results of a systematic review of published meta-analyses, systematic reviews, and literature reviews between 1996 and 2016 which was conducted across three databases (Medline, PsycINFO, CINAHL). Using the search terms client, patient; satisfaction; medication, medical, social work, and psychiatric treatment; and engagement/adherence, a total of 1667 articles were identified. After removing duplications, 1582 articles were independently screened for eligibility (e.g., conceptual focus, methodological limitations) by research assistants, resulting in the final inclusion of 50 meta-analysis, systematic review, or literature review articles that focused on predictors or barriers to client satisfaction and/or predictors or barriers affecting engagement/adherence.

Results:

Findings from this study identified two broad factors determining or affecting satisfaction: (1) Relationship with clinician (sub-factors: multicultural competence, shared decision making, communication skills, continuity of care, empathy); and (2) Outcomes (sub-factors: therapeutic outcome, client expectations). Eight Treatment Engagement/Adherence barrier and predictor domains were identified:  (1) treatment regimens; (2) illness beliefs; (3) emotional/cognitive factors; (4) financial/logistic factors; (5) social support; (6) symptom/illness characteristics; (7) demographics, and (8) client-clinician relationship.

Conclusions and Implications:

These key findings will provide researchers and practitioners with strategies, tools and resources to incorporate in studies and to enhance professional relationships between clinicians and clients.  These research and clinical strategies, tools and resources can inform future research initiatives, improve the health care for underserved and vulnerable populations, to improve treatment engagement and help to close the health care gap.