The use of Protection-Motivation Theory to support patient adherence in perioperative care, rehabilitation and other settings: protocol for a scoping review.

In scoliosis, the spine develops in a curved shape, leading to distress and discomfort. An effective treatment for scoliosis is the use of a back brace, which helps to adjust the spine to a normal curve. For the best outcomes, patients are advised to wear their back brace for 18 hours each day, often over a period of several years. Adherence to the 18 hour treatment reduces the risk of needing subsequent back surgery from 48% to 28%. However, research has found that compliance can be poor, with one randomised controlled trial identifying that the mean time spent wearing a back brace is only around 12 hours per day. The gap between ideal adherence and actual adherence exists for many treatments, leading to worse outcomes. 

One approach to improving adherence could be through the use of theory when developing an intervention. The MRC suggests that theory should be used to guide the development and implementation of interventions to improve health. 

Protection-Motivation Theory (PMT) has the potential to improve adherence to treatment. PMT proposes that health-related behaviour, like adherence to treatment, can be understood according to two broad themes - threat appraisal and coping appraisal. Threat appraisal considers how severe a threatening event is and how vulnerable an individual perceives themselves to be. Coping appraisal is the individual’s appraisal of their ability to respond to that threat. PMT holds that people are more likely to engage in healthy behaviour if the threat of harm is high and they are well equipped to cope with that threat. Conversely, where the perception of threat is low and a person’s perceived ability to cope with that threat is low then healthy behaviours are less likely to occur. 

This scoping review will aim to look at the extent to which PMT has been used in the development of interventions to improve adherence to treatment.