Compliance to treatment in patients with chronic illness: A concept exploration.
BACKGROUND
Patients' compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition.


METHODS
Theoretical phase of Schwartz-Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords "Compliance," "Non-compliance," "Adherence," and "Concordance." Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen.


RESULTS
The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research.


CONCLUSIONS
This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained.
Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran.
Forough
F
Rafii
Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran.
Naima Seyed
NS
Fatemi
Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
Ella
E
Danielson
Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
Christina Melin
CM
Johansson
Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Mahnaz
M
Modanloo
Adherence; chronic illness; compliance; concept analysis; hybrid model