Exploring Inter-Agency Working in Relation to Client/Patient Journey in My Area of Practice, Palliative Care - Essay Example

Critical Path Analysis: Exploring Inter-Agency Working in Relation to Client/Patient Journey in My Area of Practice, Palliative Care 1: Introduction: Two decades ago, it was the practitioners who had been dominating the health and social care environment with the patients/service users being placed at the lower end of the spectrum as passive takers of such services. This has been gradually shifting, thanks to the approach of the Government, whose rhetoric now promotes the principles of choice and control for service users within a seamless service (Barrett et al, 2005). This has brought in a paradigm shift in the delivery of health care services, wherein, the earlier 'professional directed approach' is being replaced by a 'person-centered approach' which demands practitioners to tune their thinking and implement practicing to the needs, desires and the rights of the users of health care services. If this is the development that has been taking place in the health sector, which places emphasis on social care, it is imperative to consider its implications from a theoretical and practical perspective and that is the central objective here. It would critically explore the values and concepts of Inter-Agency (IAW) approaches with specific reference to palliative care. Before navigating into specificities connecting them to 'palliative care', one would identify some of the general concepts through a literature review. Corresponding to the above, the second section is a literature review, the third a critical discussion of issues associated with the chosen area of study, and the fourth a conclusion with a format encapsulating what was achieved with reference to what were the requirements. A major challenge this writer poses need to be highlighted. It relates to 'jargons and terminologies.' For instance, from a practitioner's point of view, the term 'patient' has been used in a generic fashion, which may not gel with the way midwives or social workers use it. To midwives, there has been an extended meaning to such terms as women- or child-catered care to include their families. In the same manner, social workers more often use the term ‘service users/carers' whereas the occupational therapists treat them as their 'clients.’ For the purposes of this paper, the definition of Overetveit et al (1997) produced herein under is taken: "If one of the purposes of interprofessional working is the combining of different perspectives then the patients or service users are interprofessional workers par excellence [since] they...unify and combine the different advice and perspectives integrating them into daily living and making health choices as they do so" (p.117). 2: Literature Review: This review centres around five theoretical concepts, as identified by Leventhal and Cameron (1987) that are considered to be relevant to this paper, which are: (1) bio-medical; (2) behavioral; (3) communication; (4) cognitive; and (5) self-regulatory. In the bio-medical theory as elsewhere pointed out in this paper, the patients are taken to be passive recipients of doctors' instructions; the absence of good health or presence of disease is traced to bio-medical causes and the treatment is based on the patient's body. The solutions are mechanical reflected in a prescriptive regime, and the non-adherence to treatment is traced to the physical characteristics of the patient (Ross, 2004, & Blackwell, 1992). A major limitation of this theory is that it takes into account only the patient characteristics that may impact their health behaviour. The Behavioral theory places emphasis on the learning perspectives and focuses on the environment and the teaching of skills to manage adherence (WHO, 2003). It treats behaviour as a product of antecedents which could be arising out of internal or external factors, as thoughts and environments respectively and the consequences of them could be reflected either in the form of punishments or rewards. The limiting factor of this theory is the lack of an individualized approach and also the tendency in not taking into account the factors that consciously influence the behaviour that is not linked to immediate rewards. Communication theory places the emphasis on patient-practitioner relationship (Rose & Deverell, p.56) and is based on patient education and good health care worker communications skills. It further relies on three factors: treatment, instruction and comprehension. In this context, the academicians and researchers have started to emphasise the concept of 'narrative-based medicine' to promote the physician-patient based communication which is found to promote the physician-patient based communication and enable a better outcome on the health of those undergoing treatment. The principle behind this concept is the emphasis that is laid down on the information-sharing between the two during the medical interview, and such a perspective—though the research has supported to have positive outcomes…—has been found in reality to be lost (Platt & Platt 2003). Major criticisms of this theory centre on its not taking into account attitudinal, motivational and interpersonal factors that may interfere with the reception of the message and the translation of knowledge into Behavioral changes. Nevertheless, among all the approaches, this is considered to be the cornerstone of every patient-practitioner relationship and most relevant to this paper and of late more and more reviews are being undertaken to determine the effects communication elements ( Lewin et al, 2001, & Griffins et al, 2004). The cognitive model bases its arguments on a number of sub-elements, the chief among which are health-belief, socio-cognitive factors, reasoned-action, planned-behaviour and protection-motivation. The health-related behaviour is based on certain attitudes, beliefs, the outcomes of the expectations based on a futuristic perspective. (Stroebe, 2000, & Gebhardt & Maes, 2001). The basis of these approaches suffer from the weaknesses of not accounting for non-voluntary factors that could affect behaviour, sub-optimal outcomes from a cost-benefit analysis, power relationship and social reputation (Weinstein ND, 1989, & Ingham et al, 1992). According to health belief theory, health behaviour is based on the outcome of a rational appraisal that is arrived at through a balancing of barriers to and benefits of action. It relies on the demographic and socio-psychological variables to construct the barriers and benefits (Redding et al, 2000). The threats to health and benefits out of the outcomes of the treatment are the major factors that influence the behaviour. This theory is criticized, firstly, for the lack of empirical evidence of the relationship between the variables and secondly, for the non-inclusion of social influence (Stoebe & de Wit, 1996). Self-regulatory theory focuses itself on the patient, advances that it is imperative to examine the individual's subjective experience of health threats to understand the manner in which they adapt to these threats and they form the cognitive representatives of health threats by committing new information with past experience. Its central theme is that people, by engaging themselves into active and self-regulating behaviour, are the problem -olvers of their illness (Leventhal et al 1987). The main criticism relating to this theory is that it is more intuitive rather than evidence- based. These theories can broadly be reduced into two philosophies which currently drive the interprofessional practitioner-patient models, which are the medical and social models. The medical model relies on the belief of medical experts in that they know what is the best for their patients whereas the social model lays emphasis on issues of power in the professional role (Thompson, 2007) and though curiously looks at as to how the 'helping' relationship can also prove to be disempowering and produce a level of dependency on the professional (Shakespeare, 2000). Inter-agency working (IAW), put in another way, is nothing but collaborative working which has the support of those who have seen for themselves the advantages of working with diverse disciplines in a perso-centered care (Braye & Preston-Shoot, 1995). At the same time, interprofessional working also calls for a significant reorientation of professional working practices (Barrett et al, 2005) If this be the case, one has to focus at finding out what are those factors that govern the interprofessional working. Awareness at work, both at organizational and interpersonal levels—which falls under the academic psychology—includes the structural issues that weave around various elements of the players. Both practitioners and users involved in the health sector have to face the cultural issues including anti-divinatory practices, whether based on religion, sex and or age, which are some of those important factors. The plays of such factors also imply a shift from patient-to-person entered care. However, with regard to palliative care, there are two theories which may be appropriate for being mentioned here. The 'Praxis Theory of Suffering' focuses on the Behavioral-experiential nature of suffering. Here, suffering is perceived as comprising of two behavioural states, enduring and suffering. Enduring is characterized by suppression of emotion whereas in the other case, it is manifested in a state of distress in which the emotions are released. The complexity theory compares the palliative care to the physical, biological and social systems. As they have been found to have relevance in those areas as broad as meteorology, biology, organizational theory etc, the same is also being applied and evaluated in order to find its relevance to the field of palliative care. 3: Discussion of Values and Concepts With Specific Reference to Palliative Care: Having dealt at considerable length on the theories that govern the practitioner-patient interprofessional and inter-agency working, the rest of the paper is devoted to specific discussion of various issues with specific reference to palliative care. (i): Definition: According to the definition provided by the World Health Organization (WHO, 1990), “Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain or other symptoms and psychological, social and spiritual problems in this context are of paramount importance.” (ii): Shared Values and Ethics in Palliative Care: Ethike is a Greek word from which the word ethics is derived. Ethos is a value which one has and consistently applies to one’s life. Within the palliative care setting, there are three aspects of patient care that need special attention: the realms of the palliative care patient; the realm of the palliative care nurse; and the realm of the palliative care team. The realm of the palliative care patient is mainly concerned with the patients’ well-being even though he or she is in the end stages of terminal illness. The patient is still given treatment, in most instances, for what ails him or her, but the patient is prepared to die at any moment. Thus, palliative care focuses on maintaining a sense of homeostasis within the patient even tough, unfortunately, the patient is ultimately most likely going to die of his or her disease in most cases instead of being discharged from palliative care. The most important thing to remember when dealing with a palliative care patient is that there are many things that a supportive caregiver or family member should as well as should not do. Therefore, people must be sensitive to these areas of the palliative care patient’s psyche which could be easily damaged. First of all, the palliative care patient does not want to be lectured; especially, it is important not to blame a patient for his or her illness. For example, saying things like, “Well, if you hadn’t smoked all your life, you wouldn’t have gotten lung cancer.” Or, someone might be thoughtless enough to say something like, “If you had eaten healthier earlier in life, you wouldn’t have had…” fill-in-the-blank—chronic health problem X, Y, or Z such as heart failure, diabetes, cancer, etc. Additionally, if a palliative care patient has cancer, it is tempting to want to demonstrate Lance Armstrong Syndrome. The idea that if a person has a strong mind and a positive mental attitude (PMA), one will overcome cancer—is an illogical fallacy. Although there is indeed much debate about “mind over matter” in medicine, the bald truth is that cancer is a very tangible problem which cannot simply be overcome by someone just willing it to be so with the power of their mind. Truly, a positive attitude is not the only thing that one must have in order to beat cancer. One also must have the biological predisposition to overcome the cancer. In other words…if the underlying pathology of the patient suggests that he or she will continue to be ill, that is exactly what will happen, and he or she will not be able to overcome the illness by simply willing it away—no matter how strong their psychic faculties be. One fundamental flaw about people with Lance Armstrong Syndrome is that they assume that someone must be weak-willed or having lack of fortitude of mind if they cannot overcome cancer by simply having a positive attitude. This is, again, an illogical fallacy. Now, clearly, there are people who are of the philosophical bent which ascribe to the theory that one can overcome illness by simply having enough faith. Again, this is also an illogical fallacy which may be difficult for some to overcome. However, it is a must that people heed the fact that not everyone is going to be a cancer survivor. Realizing this fact is facing reality. Sometimes people are not realistic in their assessments, i.e., dealing with their relatives who are in palliative care. For example, they may think mistakenly, or perhaps, were led astray to believe, that their loved one, if cared for enough, would somehow miraculously recover. Many family members of patients who are in palliative care mistakenly assume, many times wrongly, that their loved one will indeed get better. However, sadly, this is usually not the case. What is common is that the patient’s condition deteriorates, and the family is suddenly caught in arrears because, unfortunately, they have a difficult time accepting the inevitable—the fact that their loved one is dying. This is the phase of the dying process called denial. They slowly then come to acceptance after having just been in disbelief. They then move to denial and then acceptance. Unfortunately, the family may have a more difficult time than the patient. The family has a difficult time basically because they are the ones who are left behind to contemplate the meaning of life without their loved one. In essence, funerals are then, not for the dead but for the living. Truly, it is possible for someone who is dying of cancer to overcome their illness. But, for a family to hold on hope that their loved one will definitely get better is a false hope in palliative care practice settings. Understandably so, palliative care nurses must be continually assessing and evaluating the needs of the palliative care patient. Are the patients’ medications at the correct dosages? Do they need to be adjusted? The duty of the palliative care nurse is to continuously be monitoring a patient’s relative progress or the lack thereof. A palliative care nurse, if there is any significant change in the patient’s status (positive or negative) should make notes of this in his or her care plans and make contingency plans to provide for any changes in temperament in the patient. The duty of the palliative care team is to reassure that all the patient’s needs are coordinated. Usually a palliative care team consists of: the nurses that are working on all of the palliative care patients; the main doctors which oversee the palliative care setting; the social worker; the chaplain; and perhaps most obviously, the family and/or caregivers. It is the duty of the palliative care team on the end of the hospital or other organization taking care of the patient—not now speaking of the family and/or caregivers—that they establish a sense of trust and reliability with the patient. Since the palliative care nurse is the person who will have the most contact with the patient, it is of maximum importance that the nurse be professional, respectable, and affable. It is the duty of the other nurses to patiently listen as each individual nurse expresses his or her reflections on the progress of the patients. Similarly, it is the doctors’ duty to reflect on how the status of the patients are. The social worker is available in order to address any issues that might come up regarding the patient’s living conditions, environment, etc. The chaplain is available in order to help out with a patient’s spiritual needs. In any case, the palliative care team is very important, and of course, one cannot forget the importance of the role of the family and/or caregivers, which must work with the hospital’s or organization’s palliative care team members. The palliative care team works together to provide the service of helping the patient through this troubling and complex time in his or her life. Hopefully the team can make that patient’s journey an easier and perhaps less stressful one. (ii)Requirement of Skills Needed for Inter-Agency Working in the Area of Palliative Care: The demand for palliative care education for generalists would grow along with the spread of such a care. Provisions hence would have to be made for the practitioners, irruptive of their fields of specializations, to have easy access to courses and short term clinical attachments. Within the general education, there has to be more emphasis on 'modular education,' especially for the nursing professionals. With the advent of the Internet and technological developments, more reliance could be placed on distance-learning which can further be accelerated by especially providing such facilities by catering to the needs of those working in residential homes. At a higher level, institutions of higher learning could augment the facilities by creating professional chairs in medical, nursing and social work. As else where pointed out in this paper, the current paucity in research could be made good if funding bodies and pharmaceutical industries recognize the relevance and need for palliative care. (iii) Inter-Agency Working and Palliative Care: A vast magnitude of the population in the UK (over 2,300,000) is reported to be afflicted with cancer. Patients and their families face shocks, uncertainties and need support at all stages. Though such a support was available, yet, in one of the surveys (DOH, 1999-2000), it was revealed that there were still considerable number of such patients who stated that they did not receive the information and support they needed and all the more showed considerable variations in the quality of care delivered across the country and one of the reasons for this was attributed to the poor interprofessional communication and coordination. The National Health Service (NHS) and the National Assembly for Wales in England have been directed to and engaging themselves in and developing standards, having realized that effective face-to-face communication between health and social care professionals is important, on the one hand. Patients and caregivers, on the other hand, is fundamental to the provision of high-quality health care, yet, in practice it was found that much of the professional support furnished to the patients afflicted with advanced cancer was delivered by non-specialist social and health care professionals in palliative care which has been an area of concern. In this regard, it is indicated that there is also a paucity of literature and in order to fulfil this gap, it is widely perceived that budgetary provisions should be enhanced. (iv): Determining the IAW effective measures without the rhetoric: The disparities in the provisions of the palliative care around the world have given rise to a new genre of rhetoric in that it is seen as a human right belonging to the arms of international law. So much of rhetoric dominates the literature about the entitlement of people needing palliative care in the name of human rights, but, when removed from such rhetoric, the realities which remain are totally different. This is explained with reference to one sensitive topic, i.e., assisted suicide. Compassion and the right of the patient to die are two commonly-presented reasons in favour of the concept of assisted suicide. Emotions are wrought by the usage of compassion because of its universal appeal. But when divorced from emotions, it would become clear that compassion can be distorted and harmful. In this particular case, the human beings would be deprived of their dignity, and in effect it would mean their being killed. It may be a moral reason for relieving the humans from the sufferings that terminal illness brings on them, but, not a moral justification for ending a human life. In effect, while handling terminally ill patients needing palliative care, the leaders of governance, policy-makers and the practitioners all should remove themselves from such rhetoric and engage themselves in efforts that would make such a life as comfortable as possible without injecting further sadness into them. (v): Critical Pathways for Inter-Agency Working: The origins of Integrated Care Pathways (ICPs) or the Clinical Care Pathways as it is known in the recent literature could be traced to the USA. It is developed by a multi-professional team involved in the caring process, has to be based on evidence and should follow prescribed guidelines. It deals with the process of care that is delivered in a given clinical situation. It sets the role of each health care professional in the care of the patient and the caregivers and the details of the expected outcomes which are recorded on the ICP. As and when the expected outcome is not achieved, then the reasons for such an outcome are documented and such deviations are termed as 'variance'. It is through a review of such variances future educational needs would be identified which in turn would help in the improvement of health deliveries in the future. ICPs thus in effect are a dynamic in nature and in being done over and over one document may replace another which process may continue until a central coordinating document emerges. The applicability of ICP in palliative care rests on the principle of holistic care in which the patient and carers are involved. While it does not prevent the delivery of individualised care, it simultaneously allow for the clinical freedom to furnish care within an evidence-based setting. In a palliative care environment, it has the effect of acting as a multi-professional document which the professionals can use to coordinate and record the care of the patient. Its ascendancy to prominence in the UK is of recent origin. The current emphasis in this regard is on the definition advanced by Barr (2001), which focuses on interprofessional education which departs from the earlier multi-disciplinary approach to education. The critical pathway in this is collaborative practice. This implies that the Inter Professional Education (IPE) aims at involving the patients/service users and carers as experts. The implementation of the National Service Frameworks (NSFs) and their expansion into covering more diseases has heightened the need for collaborative working between health and social services that would ultimately bring in a holistic approach to patient care (DOH, 2002a). Primary care in this connection has been identified as the key driver in the implementation of the NSFs. In regard to the development of the critical pathway, this again is seen as involving the whole workforce in the provision of first-level care. In other words this is described as an 'interprofessional framework’ or tool by the DOH. This implies for the critical pathway further to develop interagency working would bring in innovations in patient care. While the importance of education programme in an ICP is over recognised, yet in practice, it is underachieved. One common reason for this is the excessive work load of the professionals and exposure to theories in them do not bring in any change in the practices. This is because implementing an ICP demands a major commitment in terms of time because of the need to comply with a lengthy procedural requirement. Nevertheless, this does not in any way undermine the importance of developing and implementing an ICP, as if the health practitioner community as a whole is familiar with such tools as and when they commence their entry into the profession, they would usher in a powerful model for delivery of care. Clinical pathways thus bring in a refreshing approach to the dissemination of clinical excellence in palliative care. Within it one can develop a number of sub-models that would address specific requirements. This may help the patients in breathing their lasts in a dignified environment. It also contains the potential to set standards and for being used in quality assurances within a palliative care and or hospice setting. It also sets in motion a change in the mindset in the culture for the care of dying. In essence, the critical pathways should and would lay emphasis on the delivery of a multitude of national priorities through networks and collaborations across the National Health Service (NHS) that would include social care, local government, voluntary and independent sectors. Partnership working would call for working not only across agency boundaries but also professional boundaries. 4: Concerns and Possibilities: Multi-professional working in the UK is looked at as a driver of social inclusion, but, the problem is the policy directives are considered to be running ahead of conceptualisation. This is especially so in as minimal attention has been considered to be paid to conceptualising the forms of professional learning that is required to expand the interagency practice and there does not seem to be any theoretical backing in the practical implementation of inter-agency work. This paper deals with some of the concerns that have come into focus in this regard. The UK Government since at least the turn of the 21st century has been giving priority to tackling social exclusions, which are defined as the loss of access to life chances that connect the individuals to the mainstream of social participation. Interagency collaboration is seen as a vehicle to achieve such social inclusion which are seen in the initiatives as Health Action Zones. While at policy level multi-professional working is seen as a 'self-evident good,' problems have cropped up in both strategy and operation. The inter-agency model of working rests upon 'non-conflictual' models of collaboration, but, in reality it denies the tensions that exist between different agencies both at vertical and horizontal levels. Moreover, the problems have been identified and discussed by confining them to managerial or technological issues ignoring the human factors. The conceptual framework obtaining at present places minimum emphasis upon the need for agencies to learn the working something as a 'learning process' in which there are as much tensions and difficulties as insights and motivations. Of particular concern in this regard is the tendency to use partnership and participation in an interchangeable manner. It is indeed considered, a pitfall, if one were constrained to use that term, that to pursue post-bureaucratic analyses of professional practices. This is more than reflected in the current practices followed to prevent 'social exclusion'. For instance, a single child in the current scheme of things may have to encounter multiple agencies spanning the education, health, social services and similar but multifarious agencies that have the effect of only exacerbating an already existing contentious relationship. Effectiveness is equated with the containment of distribution to a moderate form and diminution of conflict. There is perceived to be an organisational ambivalence in the inter-agency working both at the vertical and horizontal forms. They are considered to impede the development of inter-agency working as the practitioners working at operational level regard barriers to develop in inter-agency approaches within small, short-term projects as irresolvable in a situation where the mainstream service remained divided at the top level. In a setting of this type, the senior level commitment to the multi-professional agency is considered to remain only at a rhetorical level on account of the fact that overarching departmental structures remain insulated from one another. The effect of this is that there is a wedge between micro and macro levels of collaborations. While at the micro level, there could be innovations that remain truncated as they are isolated in the macro level. The working practices did not sustain in the case of short term projects as there was no mechanism for offering the expertise of the multi-agency professionals to subsequent inter-agency projects. The inter-agency working is also considered to promote the emergence of new hybrid professional types which has resulted in the creation of 'fluidity of roles' in which the practitioners have wade through a number of boundary issues, that may either internal or external or a combination of both of them. It also poses problems of cultural change. The areas of concerns could then be summarised as the ones that relate to the conceptualisation of inter-agency working, which places multiple demands upon the practitioners and clients (patients/carers). In this context, interagency working cannot be construed as a virtuous solution and or an ideal model of service delivery. It is also equated with 'partnership' tools and considered suitable for analyses of collaboration. 4.1: Prospects: The natural question that crops up is that, “If the interprofessional working is a concept that is confronted with so many practical problems where its role in the health and social care system is, then what purpose does it serve?” This section of the paper would argue the case in general and not relating to palliative care alone as the picture is to be seen in a broader perspective. In the UK context, it is seen as a remedy to the past failings of the health care system and something which would bring in sweeping changes in the delivery of caring in regard to at least that section of the population which needs it badly, namely, the adolescents. Adolescents make up a considerable proportion of the population in the UK with the reported data of about 15% of the total population falling between the ages of 10 and 20, with the projections between 1998 and 2011 suggesting that it would grow at an annual rate of 8.5%. It is of concern to note that mortality is still predominant in this age group when compared with other groups with accidents and self-harm reported to be claiming as major causes of loss of lives. They also undergo significant mental health problems. The present Child and Adolescent Mental Health Services are seen to be inadequate to cope with their problems. There is also a diminished level of attendance by them to health care services. The reasons mentioned above are sufficient to bring in the point that there has to be better methods to attend to their health care needs. In a primary care setting, they relate to access, confidentiality, consent, and privacy. 5: Conclusions: The conclusions that emerge from this paper are that: Young people have felt that they face barriers to the effective use of both primary and secondary health care services. They pertain to lack of information, unfriendly services, sandwiched either with the children or elders in the hospitals and, in short, health services would have to pay greater attention to the special needs of them if the delivery health care aims at improving the emotional, psychological and physical health of the population. These solutions should be innovative, and also evidence-based. Demographically, they are not a homogeneous group and have diverse special needs that are associated with gender, ethnicity, social and educational disadvantage. The fact that services for young people with psychological and mental health problems have not changed much in the last three decades or so makes the introduction and implementation of interprofessional working an imperative if their requirements have to be met. This is all the more warranted because a single style of service may not attract the young people. As a result, specific local health service provisions should take into account all other relevant service provisions including the one that is multi-professional in nature. The practitioners involved in such facilities should also be trained to take into account the specific needs of young people. The quality assurance standards should also be maintained. The development of the communication skills by the staff is considered to be of paramount importance and it yet another reason as to why interprofessional agency approach is advocated. REFERENCES Barrett, G., Selman, and D. & Thomas, G. (2005). Interprofessional working in health and social care: professional perspectives. Basingstoke: Palgrave Macmillan. Barr, H (2001). Inter-professional education: today, yesterday and tomorrow. Learning and Teaching Support Network Centre for Health Sciences and Practice. Blackwell, B, (1992). Compliance, psychotherapy, and psychosomatics. 58: 161-169. Braye, S. & Preston-Shoot, M. (1995). Empowering practice in social care. Buckingham: Open University Press. Department of Health: Nat’l Surveys of NHS Patients (2002). Cancer national overview, 1999-2000. London: DoH. Department of Health (2002a). National service frameworks: practical aid to implementation in primary care. London: DoH. Platt, C.M. & Platt, F.W. (2003). Two collaborating artists produce a work of art: the medical interview. Arch Intern Med, 163(10): 1131-1132. Gebhardt, W.A. & Maes, S., (2001). Integrating social-psychological frameworks for health behaviour research. Am J Health Behaviour, 25: 528-536. Griffin, S.J., Kinmonth, A., Veltman, M.W.M., Gillard, S., Grant, J., & Stewart, M. (2004). Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trial. Ann Far Me, 2: 595-608. Ingham, R., Woodcock, A., & Stenner, K. (1992). The limitations of rational decision-making models as applied to young people’s sexual behaviour. Gabe, J. (Ed.) AIDS: Rights, Risk and Reasons. London: Blackwell Publishers, 19-30. Leventhal, H. & Cameron, L. Behavioral theories and the problem of compliance. Patient Education Counseling, 1987 (10): 117-139. Leventhal, H., Meyer D., & Nerenz, D. The common sense representation of illness danger. Rachman, S. (Ed.) Contributions of Medical Psychology. Oxford: Paragon Press, 2: 7, 30. REFERENCES Lewin, S.A., Skea, Z.C., Entwistle, V., Zwarenstein, M., & Dick, J. (2001). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Systematic Review, 4. Ovretveit, J., Mathias, P., & Thompson, T. (1997). Interprofessional working for health and social care. Basingstoke: Macmillan. Redding, C.A., Rossi, J.S/, Rossi, S.R., Velicer, W.F., & Prochaska, J.O. (2000). Health behaviour models. International Electronic Journal of Health Education, 3: 180-193. Ross, E. & Deverell, E. (2004). Psychosocial approaches to health, illness and disability: a reader for health care professionals. Pretoria: Van Schaik. Shakespeare, T. (2000). Help. Birmingham: Venture Press. Stroebe, W. (2000). Social psychology and health, 9th Ed. Buckingham: Open University Press. Stoebe, W. & de Wit, J. (1996). Health-impairing behaviours. Senin, G.R. & Fiedler, K. (Eds.). Applied Social Psychology. London: Sage, 113-143. Thompson, N., (2007). Power and empowerment. Lyme Regis: Random House. Weinstein, N.D. (1988). The precaution adoption process. Health Psychology, 7: 355-386. World Health Organization, (1990). Technical report series. Geneva: WHO. Pp. 804. World Health Organization (WHO), (2003). Adherence to long-term therapies: evidence for action. Geneva: WHO. Read More