Bissonnette (2008) — Adherence: A Concept Analysis

Vocabulary flashcards covering the key terms, attributes, antecedents, consequences, and practice implications from Bissonnette's (2008) concept analysis on adherence.

Compliance

A term historically denoting following a prescribed regimen, often implying obedience and professional authority, which may assign blame to the patient when a regimen is not followed.

Adherence

A concept defined by the World Health Organization (WHO) as behaviour in relation to recommendations agreed with a health professional, though frequently used interchangeably with compliance and operationalized simply as following instructions in the literature.

Concordance

A concept stressing consultation, partnership, and a negotiated agreement between the healthcare professional and the patient, conceptually distinct from compliance even if measured similarly in studies.

Evolutionary Concept Analysis

A research method used by Bissonnette to analyze the changing use, context, and meaning of adherence across 53 papers published between 1970 and 2007 in nursing, mental health, medicine, and pharmacy.

Decisional Conflict

An attribute of adherence in which an individual weighs treatment benefits against costs, adverse effects, personal values, or competing priorities.

Predictability

An attribute of adherence describing patterns of treatment-taking that may be more or less consistent across time and circumstances, rather than perfectly constant.

Personal Experience

An attribute of adherence wherein the meaning of illness and treatment is shaped by the individual's lived experience, including perceived benefits and unpleasant effects.

Power

An attribute of adherence referring to how the dynamics of who defines the problem and controls the treatment plan influence the healthcare encounter.

Agreement

An attribute of adherence that invokes a mutual consensus regarding a regimen, although reviewed literature did not always demonstrate genuine negotiation.

Pervasiveness

An attribute of adherence describing how treatment regimens can extend into many parts of everyday life rather than remaining confined to clinical encounters.

Antecedents of Adherence

Prerequisites described in the literature that precede adherence, most commonly a prescribed medication or lifestyle regimen, patient willingness to accept all or part of the plan, and perception of the provider as a trusted, knowledgeable source.

Consequences of Adherence

Potential outcomes following adherence occurring across patient levels (e.g., health outcomes, quality of life, empowerment, decisional conflict), professional levels (e.g., acceptance, avoidance, ambivalence, misinterpretation), and system levels (e.g., potential reduction in service use or costs).

Collaborative Treatment Strategies in Nursing

Clinical practices that support adherence by asking what the regimen means in the patient's life, explaining options and risks in understandable language, eliciting preferences, and verifying that the plan is feasible and genuinely agreed upon.