Herrera et al. (2017) — Understanding Non-Adherence From the Inside

Vocabulary flashcards covering the study design, theoretical frameworks, pro- and anti-adherence positions, and nursing implications from Herrera et al. (2017).

Herrera et al. (2017) Study

A qualitative, descriptive, cross-sectional interview study examining how adults with hypertension explain their motivations both for and against treatment adherence.

Herrera et al. Sample Criteria

A group of $51$ self-reliant adults aged $25$–$80$ years receiving public and private care in Chile, excluding individuals with cognitive impairment, psychiatric illness, or acute comorbidities.

Adherence Patterns

The spectrum of treatment adherence behaviors evaluated in the study: optimal, sufficient, insufficient, and discontinued treatment.

Health Belief Model

A theoretical framework that examines how an individual's perceived threat, expected benefits, and perceived barriers influence their health behaviors.

Common-Sense Model of Self-Regulation

A cognitive model focusing on how patients construct mental representations of their illness and subsequently select and appraise coping strategies.

Dialogical Perspective

A framework viewing an individual as having multiple internal "voices" or positions with context-dependent meanings, serving as metaphors for competing internal perspectives rather than psychiatric symptoms.

Pro-Adherence Positions

Themes voiced by patients that support following treatment, organized around self-worth, well-being, autonomy, affiliation, and ease or effort.

Anti-Adherence Positions

Themes voiced by patients that explain resisting or stopping treatment, categorized under self-worth, well-being, autonomy, affiliation, and lack of motivation.

Self-Worth (Pro-Adherence)

An adherence motivation where engaging in self-care and medical treatment is viewed as a tangible demonstration of self-respect.

Self-Worth (Anti-Adherence)

A non-adherence motivation where rejecting medications or resisting the identity of being a patient serves to preserve a personal sense of strength.

Autonomy in Hypertension Management

A patient value that can motivate adherence to protect personal independence through self-management, but can also motivate non-adherence when a medical regimen feels overly controlling.

Affiliation in Hypertension Management

A social value that encourages treatment adherence to care for loved ones and accept support, but can discourage adherence when strict diets disrupt shared meals and social belonging.

Well-Being (Anti-Adherence)

An anti-adherence perspective in which treatment routines cause anxiety, reduce quality of life, or create concerns regarding drug side effects and physical harm.

Lack of Motivation (Anti-Adherence)

An anti-adherence interview theme characterized by expressions of hopelessness or the perception that the effort required for treatment is not worthwhile.

Coexistence of Adherence Positions

The empirical finding that $49$ out of $51$ participants in the Herrera et al. study simultaneously expressed both pro-adherence and anti-adherence viewpoints.

Person-Centred Adherence Strategies

Nursing approaches that utilize open questions, reflect opposing patient views without arguing, ask permission before discussing risks, and negotiate options to align with patient values and routines.