'The hand belongs to someone': a therapist perspective on patient compliance

Background: Compliance is considered to be a central element of effective health systems. In terms of rehabilitation, both nonattendanceand non-compliance of patients with hand injuries in South Africa have been reported. This study explored how occupationaltherapists practicing in the field of hand therapy, understand compliance and its perceived barriers and supports.Methods: A qualitative descriptive research design was employed. Nine occupational therapists who routinely treat patients with haveconditions were purposively sampled. In-depth interviews were conducted, transcribed and inductive thematic analysis undertaken.Results: Therapists' understanding of compliance demonstrated elements of consensus and difference. Four themes captured participants'views of barriers and supports: compliance is enabled when a powerful collaboration exists between the client and the therapist. For thisto be possible, the therapist needs to understand the life and times of an injured hand, co-constructing therapy on the foundation ofunderstanding the patient as an occupational being. Powerful collaboration is further enabled by effective communication for collaboration,and lastly the characteristics of systems and services that work hold power to hinder or enhance compliance.Conclusion: Results suggest that collaborative co-authoring of the hand rehabilitation process is central to enabling compliance.Therapists require a robust understanding of the person they are treating and the complex context in which the person participates.Accessible communication, effective education and enabling systems and services are also vital. Furthermore, the way in which occupationaltherapists conceptualise compliance matters. Critical reflection is necessary to interrogate the philosophical assumptions that underpinthe terminology that occupational therapists choose and how power is navigated in relationships with patients with hand injuries. Key words: Hand therapy, adherence, shared decision making, low to middle income country