Rafii Forough, Fatemi Naima Seyed, Danielson Ella, Johansson Christina Melin, Modanloo Mahnaz
Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran.
Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
Iran J Nurs Midwifery Res. 2014 Mar;19(2):159-67.
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.
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.
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.
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.
患者对治疗的依从性是评估慢性病管理成效的一项重要指标。尽管需要一个适用的依从性定义来进行适当的干预和研究，但这一概念并不清晰，对于其含义、定义和测量方法也未达成共识。本研究旨在探讨依从性的概念并制定一个实用定义。
采用施瓦茨 - 巴科特和金的概念分析混合模型的理论阶段来分析依从性概念。通过文献综述收集数据。使用关键词“依从性”“不依从性”“坚持性”和“一致性”在1975年至2010年期间检索了Medline、CINAHL、Ovid、爱思唯尔、Pro Quest和布莱克韦尔数据库。如果英文发表的文章纳入了成年慢性病患者并报告了依从性的属性，则将其选中；共选取了23篇此类相关文章。
依从性的属性包括患者的顺从、执行医疗建议的能力、灵活性、责任感、合作、参与以及坚持执行建议。先决条件分为两个相互作用的类别：内部因素指患者、疾病和治疗特征，外部因素指医疗保健专业人员、医疗保健系统和社会经济因素。依从性可能导致 desirable 和undesirable 的后果。通过将现有定义与其在临床实践和研究中有用的属性进行比较和对比，制定了依从性的实用定义。
这一发现将在临床实践和研究中有用。但这个实用定义必须在临床环境中进行测试，并获得其适用性的广泛观点。
