Treatment adherence: a concept analysis

BACKGROUND: Fewer than half of patients with chronic diseases consistently adhere to recommended treatment regimens. Conceptualization of the terminological system of treatment adherence is necessary to improve the consistency and evidence base of studies addressing microsocial determinants of health. AIM: This work aimed to perform a concept analysis of treatment adherence from the perspective of the sociology of medicine. METHODS: Concept analysis of the studied concept (demarcation and clarification of its content), as well as lexical and etymological analyses, were performed. To assess the prevalence of terms in the scientific publications, a frequency analysis of their use was conducted, on the basis of which temporal trends were identified. RESULTS: The evolution of concepts in Russian terminology progressed from paternalistic constructs such as compliance and concordance to the English term adherence and the Russian calque adherence. The author proposes a 3-component model of adherence, including cognitive (knowledge about the disease), affective (emotional attitude), and behavioral (following recommendations) components. Internal dialectical contradictions of the concept were identified, and ethical aspects of patient responsibility in the context of the predominance of physician professional responsibility were highlighted. The use of the studied terminology in Russian regulatory legal acts demonstrates recognition of the socioeconomic significance of the problem. CONCLUSION: The conceptual analysis clarified the scope and content of treatment adherence from the perspective of the sociology of medicine and enabled the author to propose an original theoretical construct represented by a 3-component model of treatment adherence.