Methods: The concept adherence was examined using Rogers’ Evolutionary Concept Analysis method that identified attributes, surrogate and related terms, antecedents, and consequences of adherence based on findings from the existing literature. A model case using a clinic scenario further analyzed this concept. An electronic literature search was conducted using PubMed, CINAHL, ProQuest Central, and PsychInfo databases to identify relevant articles on patient adherence using the following keywords: “Adherence”, “treatment plan,” “patient”, “therapy” and “prescribed”.
Results: Fifteen studies were used for this concept analysis. Overall, adherence is defined as an individual’s behavior to follow a prescribed treatment plan recommended by a healthcare provider. Compliance is often used as a surrogate and related term to adherence. Five attributes emerged from the literature: Individual health behavior, behavioral adaptation, agreement, consistency, and commitment. Ten antecedents of adherence were identified: Potential for or actual presence of a disease; prescribed medical treatment or provider recommendation; patient-provider communication; perceived risk and severity of disease or benefit of treatment; motivation; self-efficacy; lifestyle changes; health literacy; care coordination; and access to care. Consequences of adherence include improved health outcomes, reduced healthcare costs, effective prescribed treatment, and reduced morbidity and mortality resulting in fewer hospitalizations.
Conclusion: The current literature dominantly focused on adherence in respect to secondary and tertiary prevention (i.e. medication regimen in treating existing diseases) with limited research in primary prevention (i.e. completing immunizations, smoking cessation, increasing physical activity, etc.). Further, many studies did not consider cultural factors, lifestyle, behaviors, and environmental factors (i.e. community infrastructure to support safe physical activity) that may influence patient adherence. Lastly, adherence is currently measured by health outcomes determined largely by healthcare providers. Future research may consider focusing on differences in patient adherence according to outcomes that matter most for patients. Future research should also consider exploring patients’ behaviors in preventative care to improve overall health outcomes through disease prevention and how individuals’ behaviors and lifestyle conditions impact their ability to adhere to prescribed treatment plans.