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ADHERENCE: CONCEPT ANALYSIS

NAME: ABEBE TADESSE

ID NUMBER: DBU1700151

ASRAT WOLDEYES HEALTH SCIENCE CAMPUS, SCHOOL OF NURSING AND

MIDWIFERY, DEPARTMENT OF NURSING

CORES TITLE: THEORETICAL FOUNDATION OF NURSING

INSTRUCTOR: SISAY.S (Ass.professor, MSC in PCH)

SUBMITION DATE: December 17, 2024

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Adherence Concept Analysis

Back Ground

Adherence is an essential concept in healthcare, particularly when it comes to chronic disease

management, medication use, and lifestyle changes and is an important modifier of health system

effectiveness (WHO, 2003), especially on patient with chronic illness (diabetic millets,

hypertension, chronic kidney disease, heart disease etc.), those with viral infection that need

lifelong treatment to maintain viral suppuration (like HIV, hepatitis), those recuperating from

trauma, injury and so on.

According to research, low adherence is a worldwide problem, with rates varied based on the

patient group, condition, and intervention. According to Cramer et al (2008), there is a 50%

chance that people would not take their prescribed drugs as directed for long-term diseases like

hypertension, DM, HIV which can result in increased risks of complications and death. Nurses

are essential in identifying adherence hurdles and putting solutions in place to increase patient

compliance with treatment regimens because they are patient advocates and educators.

According to world health organization (2004), adherence as a multi-dimensional phenomenon

determined by the interplay of five sets of factors: the health system or healthcare team, the

disease, socioeconomic aspects, the treatment, and the patient.

Adherence is a complex issue that can be affected by many different elements. These elements

can be categorized into five distinct dimensions: social and economic influences, factors related

to the therapy, factors associated with the disease, patient-specific factors, and elements related

to the health care system (Sabet.E, 2003).

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Meaning of Adherence in Nursing Theories

King's philosophy places a strong emphasis on the nurse and patient working together to

establish and accomplish health goals. In King's concept, adherence refers to the patient actively

participating in the health process by completing goals. In studies on managing chronic diseases

like diabetes, King's theory has been used to show that goal-setting and patient involvement are

associated with better health outcomes and adherence (Sullivan-Bolyai et al., 2004).

According to Orem's theory, self-care is associated with adherence. Orem says that adherence is

crucial for the nurse to help with when a patient's capacity to take care of themselves

compromised. Nursing interventions are required to ensure adherence to the prescribed care

regimen when patients are unable to execute self-care because of a deficiency, according to

Orem's theory. Research has indicated that enhancing self-care skills by instruction and nursing

assistance improves adherence to recommended treatments (Kong et al., 2019). When managing

chronic illnesses, where long-term commitment to treatment plans is crucial, Orem's approach is

especially helpful.

Neuman's model views adherence as the capacity of patients to maintain balance through the

management of internal and external stressors. In this model, adherence to prescribed treatment

plans is influenced by multiple factors, including biological, psychological, social, and

environmental factors. Nurses using Neuman’s model are encouraged to assess these factors and

intervene when adherence is compromised by any of these stressors. Utilizing Neuman's model,

researchers have examined how socioeconomic, mental health, and social support factors affect

adherence, highlighting the necessity of holistic care approaches to increase patient adherence

(Lowe et al., 2015).

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Importance of Adherence Concept Analysis

1. Improve patient outcomes: Successful treatment outcomes are predicted by adherence.

Nurses can develop tailored treatment plans that increase compliance and enhance health

outcomes by having a thorough understanding of the elements that influence adherence

(Cramer, J. A., et al, 2008).

2. Guiding for Nursing Interventions:—nurses can create interventions that are more

successful.

3. Cost savings in healthcare: Nurses decrease needless medical expenses by encouraging

adherence (Kong, S. K., et al, 2019).

4. Patient Empowerment: nurses can empower patients and improve their involvement in

their treatment plans.

5. Application of Nursing Theories in Practice: By assisting nurses in applying theoretical

frameworks to actual clinical settings.

The Aim of Adherence Concept Analysis

To Clarify the Concept of Adherence, To Identify Barriers to Adherence, To Evaluate Nursing

Interventions, To Promote Evidence-Based Practice and to Enhance Patient-Centered Care

Definition of Adherence

Adherence: The degree to which a patient correctly follows medical advice, such as taking

prescribed medications, following dietary recommendations, and performing recommended

physical activities (Oxford English Dictionary; 2008)

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Non-Adherence: A patient’s failure to follow treatment recommendations, either partially or

completely, leading to adverse health outcomes.

Patient-Centered Care: An approach to healthcare that emphasizes the partnership between

patients and healthcare providers, focusing on individual needs, preferences, and values

(Sullivan-Bolyai, S., et al, 2004)

Operational Definition of Adherence

Medication Adherence: The proportion of patients who take their prescription drugs as directed

over a given time period (e.g., one month) (Kong, S. K., et al, 2019).

Lifestyle Adherence: The degree to which a patient adheres to changes in their lifestyle, such as

exercise, stress reduction, and good sleep habits.

Dietary Adherence: How closely a patient adheres to dietary guidelines, such as those

pertaining to food type, sodium limitation, or calorie consumption (Sullivan-Bolyai, S., et al,

2004)

Related Concepts

Compliance: is about blindly following a healthcare provider's recommendations, whereas

Adherence is about making decisions together (Tasaduq H Mir, 2023).

Concordance: Concordance places a strong emphasis on a patient-provider partnership

Persistence: Especially for chronic diseases, persistence is the term used to describe the long-

term application of a prescribed treatment (Kong, S. K., et al, 2019).

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Tentative Criteria for Adherence

1. Consistency: The patient consistently adheres to recommended health practices, such as

taking their medication, eating right, and exercising.

2. Understanding: It is evident that the patient understands the significance of adherence and

how it affects their health.

3. Motivation: The patient is driven to practice self-care practices, either internally or

externally.

4. Barriers: Defined and manageable elements that restrict adherence, such lack of support,

forgetfulness, or financial limitations (Cramer, J. A., et al, 2008).

5. Collaboration: Taking an active position in the treatment plan, which includes

establishing goals, communicating openly with healthcare providers, and making well-

informed decisions regarding (Sullivan-Bolyai, S., et al,2004)

Defining Attribute

Determining the defining attributes is an effort to try to show the cluster of attributes that are

most frequently associated with the concept and can be a list of characteristics of the concept that

appear over and over again (Walker & Avant, 2019). Based on this approach, defining attributes

of adherence are:

1. The ability to comply with the treatment: The ability of the patient to adhere to the

recommended course of treatment, which may include taking medicine as directed,

exercising physically and mentally as directed, and maintaining a particular diet or way

of life (Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo,2016).

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2. Consistency on the treatment plan: The patient can follow the strategy over time and

use it frequently. This is a sustained and ongoing state of being able to follow the

treatment plan(Kaplan A, Price D ,2020 )

3. Communication with healthcare provider:

Patients can adhere to their doctor's appointment schedule for routine illness monitoring,

consultation, and feedback and information sharing. Evidence of effective treatment is

provided by prompt evaluation of changes in illness, medication response, and overall

health (Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo, 2016).

4. Willingness to treatment: This characteristic stems from the psychology of patients who

are open to receiving treatment, while the other three characteristics are based on

behavior that follows treatment. The patient has sufficient health literacy and believes in

the free will to follow the treatment plan and the treatment of health benefits (Hood MM,

Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo, 2016).

Identify model case

Aberash was a 50 -year-old, who was diagnosed with HIV and hypertension. She went to

hospital due to cough and headache. The nurse checked her blood pressure, and it was 182/94

mmHg. Aberash met with a dr. Abreham, discussed and agreed that she should take a blood

pressure medication to control the hypertension and antiretroviral medication for prevent

opportunistic infection. In addition, some lifestyle changes (e.g., low-sodium dietary and more

physical exercise, minimized stress) needed to be made to help her control hypertension.

Aberash followed the medication recommendations, and she came back to the hospital after

1month to have her blood pressure checked. During the visit, Aberash told Dr. Abraham that she

had been taking her medication as ordered and had started a new exercise program in her daily
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life. Her friends asked her go out to eat some McDonald’s high sodium food and uncooked meat,

but she refused and kept eating a low sodium diet and cooked food. Aberash’s blood pressure

was140/80 mmHg. After 1 month, Aberash went to the hospital for another follow up visit after

6 month. She reported that she was still eating a low sodium diet, taking the medication, and

doing exercise. Her blood pressure was 123/70 mmHg and her viral load and CD4 count was

128cell/mm3 and 534cell/mm3 respectively. Aberash was encouraged and told the doctor that she

was going to continue taking the medications and maintain a healthy lifestyle to control her

blood pressure and suppress the viral load.

Borderline case

Ayele was a 24-year-old man with persistent low-grade fever for the last two weeks. He then

went to the hospital for biochemical tests and was diagnosed with an HIV infection. Doctors

require the patient to start antiretroviral treatment immediately, which is a lifelong therapy. He

was upset after the infection; he knew that this could not be cured and felt like life had been

done. After searching from the Internet, he knew the importance of treatment and willingness to

accept treatment (willingness to treatment), and he could follow the prescribed treatment and

persist all the time. However, he was worried that the healthcare providers would reveal his

privacy, and he always covered his face so that no one could see him and never communicated

with them, just left after receiving the medicine

Related Case

Related cases are related to and similar to the concept being studied but are not the concept itself.

Adisu is a 28-year-old female who was diagnosed with mild depression and sleep disorders. The

doctor prescribed antidepressant and insomnia drugs and asked her to take them every day before
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going to bed. However, she thought that her depression would ease if she got good sleep during

the night, so she only took drugs for insomnia but not for antidepressants every night. Two

weeks later, her depressive symptoms worsened, and she required higher doses of sleeping pills.

She failed to adhere to taking the medicine as preserved and had to go to the hospital again to

seek help from a doctor

Contrary Case

In the following case, defining attributes of treatment adherence were not included.

Despite having no clinical signs, Tesema, a 23-year-old, was diagnosed with HIV infection. He

was very distraught, believed it could not be treated, and refused any treatments, even though

doctors told him he had to take antiretroviral medication every day. He had to earn medicine

because of the HIV control policy since he was worried that the doctor would tell his parents he

didn't take it (no willingness to treatment). He never does, however, communicate with the

medical staff. As soon as he was discharged from the hospital, he threw away his medication and

refused to stop drinking, smoking, and exercising.

Antecedents and consequences of Adherence

Antecedents refer to conditions that must be in place before adherence can occur:

Patient education: Patients need to know why they need to follow a regimen and how it will

help them get healthier.

Systems of Support: Support from peers, family, and medical experts on an emotional, social,

and psychological level is crucial for promoting adherence.

Consequences refer to the outcomes or results of adherence, which are generally positive
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Better Health Outcomes: Adherence increases the chance of recovery, reduces complications,

and improves disease management (Chun-Mei Lyu, Li Zhang, 2019).

Improved functionality: Symptom reduction and an overall improvement in quality of life can

result from treatment adherence. Patients are more likely to have fewer health issues if they

adhere to their treatment regimens.

Cost Savings: Patients and the healthcare system save money when there is less need for

emergency care or hospital stays due to increased adherence.

Empirical Referents

Measures used to evaluate adherence are known as empirical referents:

Medication Adherence Scales: Using self-reported information, instruments like the Morisky

Medication Adherence Scale (MMAS) evaluate a patient's compliance with recommended drug

regimens. These scales offer measurable indicators of the degree of adherence.

Patient surveys can reveal information on adherence patterns by asking patients about their

treatment practices, difficulties, and motives (DiMatteo, M. R., 2004).

Clinical Indicators: Indirect markers of adherence can be obtained by tracking clinical

outcomes like blood pressure, blood sugar, or cholesterol levels. Better adherence is frequently

suggested by positive changes in these measures (Sabate E, 2003).

Discussion
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A key idea in both nursing and medicine is adherence. As the number of persons with chronic

illnesses has increased, more research has been carried out. Both practice and research have

examined adherence and ways to improve it. To find defining characteristics, model instances,

antecedents and consequences, and empirical referents of adherence, adherence concept analysis

was employed. Ability, willingness, consistency, and communication were the four main

differentiators that were utilized to determine the characteristics of adherence. The health sector

may be able to comprehend adherence better and develop fresh approaches to enhance it by

employing these crucial defining characteristics (Haynes, R. B., McDonald, H. P., & Garg, A. X.

(2008)).

Conclusion

The ability of a patient to participate in therapy, communicate with their healthcare practitioner,

and consistently follow their treatment plan is referred to as adherence (Cramer, J. A. et al,

2008). In order to better educate nursing professionals about adherence, enhance clinical nursing

practice on adherence, and improve healthcare standards, this study defines adherence, discusses

its origins, uses, definition characteristics, model and opposite situations, antecedents,

consequences, and empirical references

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Reference

 Cramer, J. A., et al. (2008). "Medication adherence and health outcomes: A systematic

review." Journal of Clinical Pharmacology, 48(4), 275-284

 DiMatteo, M. R. (2004). Variations in patients' adherence to medical recommendations:

a quantitative review of 50 years of research. Medical Care, 42(3), 200-209

 Kaplan A, Price D. Treatment adherence in adolescents with asthma. J Asthma Allergy.

2020;Volume 13:39–49. doi:10.2147/JAA.S233268

 Haynes, R. B., McDonald, H. P., & Garg, A. X. (2008). Helping patients follow

prescribed treatment: clinical applications. JAMA, 288(22), 2882-2889.

 Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo A. Managing severe

obesity: understanding and improving treatment adherence in bariatric surgery. J Behav

Med. 2016;39(6):1092–1103. doi:10.1007/s10865-016-9772-4

 Kong, S. K., et al. (2019). "Nurses' role in enhancing self-care in patients with chronic

conditions: A review." Journal of Clinical Nursing, 28(15-16), 2840-2852.

 Lowe, A., et al. (2015). "The impact of social support on adherence to treatment in

patients with chronic illness: A nursing perspective." Journal of Advanced Nursing,

71(3), 529-537.

 Norris, S. L., Lau, J., Smith, S. J., Schmid, C. H., & Engelgau, M. M. (2002). Self-

management education for adults with type 2 diabetes: a meta-analysis of the effect on

glycemic control. Diabetes Care, 25(7), 1159-1171.

 Oxford English Dictionary; 2008. Available

from: http://www.oed.com/;jsessionid=1C35C24E059AA7EBBA0BBD226D04B997?

showLogin=false. Accessed May30, 2008.

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 Sabate E. Adherence to long-term therapies: evidence for action:

Weltgesundheitsorganisation; 2003.

 Sullivan-Bolyai, S., et al. (2004). "Goal setting in diabetes management: The nurse's

role." Journal of Diabetes Nursing, 8(3), 102-107

 Tasaduq .H Mir (2023). "Adherence vs compliance ". HCA health Care Journal of

Medicine (p,1)

 World Health Organization (WHO). (2003). Adherence to long-term therapies: evidence

for action. Geneva: World Health Organization