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Cited by 45Medication Adherence and CompliancePsychotherapy Techniques and ApplicationsPsychiatric care and mental health services

Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis

Open access
Laranjeira, Carlos, Carvalho, Daniel, Valentim, Olga, Moutinho, Lídia, Morgado, Tânia, Tomás, Catarina, Gomes, João, Querido, Ana·2023·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph20053869PMC PMC10001153
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Abstract

Patient therapeutic adherence lies at the core of mental health care. Health Care professionals and organizations play a major role in promoting adherence among people with mental disorders. However, defining therapeutic adherence remains complex. We used Rodgers’ evolutionary concept analysis to explore the concept of therapeutic adherence in the context of mental health. We conducted a systematic literature search on Medline/PubMed and CINAHL for works published between January 2012 and December 2022. The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors. Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness–and those related to patient-HCP therapeutic engagement. Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery. We discuss an operational definition that emerged from the concept analysis approach. However, considering the concept has undergone evolutionary changes, further research related to patient adherence experiences in an ecological stance is needed.

Verified 2026-10-09 · 2 references not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This evolutionary concept analysis of therapeutic adherence in mental health identifies patient-, microsystem-, and meso/exosystem-level attributes, patient and patient–HCP antecedents, and three consequence categories. It proposes an operational definition of therapeutic adherence as recovery-oriented, dynamic skills shaped by personal, interpersonal, and collective facilitators or obstacles.

Key findings

  • The analysis synthesized 56 articles and identified major attributes at three levels: individual (e.g., motivation/readiness to change, medication literacy, illness/symptom experience, coping, self-efficacy), microsystem (e.g., therapeutic alliance, shared decision making, family/social support), and meso/exosystem (e.g., medication regimen factors, psychoeducation, reminders, accessibility, continuity, multidisciplinary work).
  • Antecedents fell into two categories: patient-related factors (background, beliefs and attitudes, acceptance of mental illness) and patient–HCP therapeutic engagement factors.
  • Three consequences emerged: improvement in clinical and social outcomes, commitment to treatment, and quality of healthcare delivery.
  • The paper reports context numbers: in 2019 mental health disorders affected around 970 million individuals globally, corresponding to 14% of the global illness burden and 30% of the non-fatal disease burden; medication nonadherence rates were 44% in bipolar disorder, 50% in major depression, and 56% in schizophrenia.

Methods

  • Used Rodgers’ six-step evolutionary concept analysis to identify attributes, surrogate and related terms, antecedents, and consequences of therapeutic adherence in mental health.
  • Systematic search of Medline/PubMed and CINAHL for English and Portuguese works published January 2012–December 2022, supplemented by reference searches and Google hand-searching; PRISMA was followed.
  • From 1489 records, 1473 were reviewed after duplicates, 232 were appraised in full text, 184 were excluded, and 56 articles were included; inclusion focused on therapeutic adherence in mental health among adults with mental disorders and/or HCPs caring for them, excluding articles not connected to mental health care and those not involving primary research.

Limitations

  • The paper states that only two databases were used, so relevant papers may have been missed; the literature mainly focused on nursing, so Rodgers’ suggestion to include 30 papers or 20% from each area could not be implemented.
  • The paper states that the macrosystem level—societal and cultural ideologies and values—was less clear because analyzed studies did not offer information about it, and there is a paucity of standardized instruments measuring therapeutic adherence in mental health.
  • The paper states that only adult patients and papers published in English or Portuguese were studied; the text also makes evident that this is a concept analysis rather than an empirical test of the proposed operational definition.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph20053869

Cites

84 of 86 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 54 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Commitment to treatment is a behavioral strategy explicitly oriented toward mental illness management.

    “Commitment to treatment is a behavioral strategy explicitly oriented toward mental illness management [36,38,45,48,62,77].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [36] Kukla, 2013, Levels of patient activation among adults with schizophrenia: Associations with hope, symptoms, medication adherence, and recovery attitudes, J. Nerv. Ment. Dis. source

      Not checked in the free run.

    • cites [38] Inder, 2019, Participation in decision-making about medication: A qualitative analysis of medication adherence, Int. J. Ment. Health Nurs. source

      Not checked in the free run.

    • cites [45] Xu, 2020, Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore, Arch. Psychiatr. Nurs. source

      Not checked in the free run.

    • cites [48] Mazzaia, 2017, Adesão ao tratamento no transtorno afetivo bipolar-percepção do usuário e do profissional de saúde, Rev. Port. Enferm. Saúde Mental.

      Not checked in the free run.

    • cites [62] Velligan, 2013, A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia, Schizophr. Bull. source

      Not checked in the free run.

    • cites [77] Monterroso, 2012, Avaliação da adesão regime terapêutico dos utentes seguidos na consulta externa de psiquiatria do centro hospitalar barlavento algarvio, Rev. Port. Enferm. Saúde Ment.

      Not checked in the free run.

  • Findingown data

    Antecedents of therapeutic adherence are those related to patients (background, beliefs and attitudes, acceptance of mental illness) and those related to patient-HCP therapeutic engagement.

    “Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness–and those related to patient-HCP therapeutic engagement.”
    Quote in the paperSubstantial claim
  • Findingown data

    The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors.

    “The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Patients place a high value on therapeutic connections with peers or mental health professionals in community settings, believing that these are essential to recovery.

    “In addition to the significance of specific care plans, patients place a high value on therapeutic connections with peers or mental health professionals in community settings, believing that these are essential to recovery.”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    In addition to patient attributes, other relational and organizational attributes of adherence were found.

    “In addition to patient attributes, such as motivation and readiness to change, medication literacy, illness–symptom experiences, and availability of personal resources, other relational and organizational attributes of adherence were found.”
    Quote in the paperSubstantial claim
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 37

  • May combine two claims.

    Findingown data

    Three consequences of therapeutic adherence emerged: improvement in clinical and social outcomes, commitment to treatment, and quality of healthcare delivery.

    “Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The literature search revealed terms related to therapeutic adherence: compliance, concordance, cooperation, maintenance, commitment, and engagement.

    “The literature search also revealed four terms related to “therapeutic adherence”: compliance, concordance, cooperation, maintenance, commitment, and engagement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The process of adherence is dynamic rather than static, involving objective and subjective personal experiences characterized by the ability to establish interpersonal skills.

    “In all analyzed studies, the process of adherence is dynamic rather than static, involving objective and subjective personal experiences characterized by the ability to establish interpersonal skills [33].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Xiao, 2015, High relapse rate and poor medication adherence in the Chinese population with schizophrenia: Results from an observational survey in the People’s Republic of China, Neuropsychiatr. Dis. Treat.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingnone given

    Therapeutic adherence is defined by two key categories of antecedents: those linked to the patient and those linked to patient-HCP therapeutic interaction.

    “Therapeutic adherence is defined by two key categories of antecedents: those linked to the patient and those linked to patient–HCP therapeutic interaction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Patient-HCP therapeutic engagement antecedents include the healthcare provider's influence, friendly and non-judgmental behavior, quality of care of psychiatric patients, and attitudes of caregivers/relatives/families about medication and illness.

    “The second category is related to patient-HCP therapeutic engagement and included factors that reported the healthcare provider’s influence [39], how their friendly and non-judgmental behavior facilitates growth [52], how this affects the quality of care of psychiatric patients, and the attitudes of caregivers/relatives/families about the medication and illness [39,73].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [39] Lin, Y.Y., Yen, W.J., Hou, W.L., Liao, W.C., and Lin, M.L. (2022). Mental Health Nurses’ Tacit Knowledge of Strategies for Improving Medication Adherence for Schizophrenia: A Qualitative Study. Healthcare, 10. source

      Not checked in the free run.

    • cites [52] Dixon, 2016, Treatment engagement of individuals experiencing mental illness: Review and update, World Psychiatry source

      Not checked in the free run.

    • cites [73] Hernandez, 2017, Families and medication use and adherence among Latinos with schizophrenia, J. Ment. Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    The impact of subjective norms on adherence and perceived social pressures (macrosystem realm) was not understood in this research.

    “In contrast, the impact of subjective norms on adherence and perceived social pressures (macrosystem realm) was not understood in this research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Therapeutic adherence is described as a fluid process that reinforces collaborative approaches between the patient and the clinician and improves the relationship with professionals, affecting satisfaction with treatment.

    “Some articles described therapeutic adherence as a fluid process that reinforces the collaborative approaches between the patient and the clinician [38,56,76] and improves the relationship with professionals [46], affecting satisfaction with treatment [34,45,62,77,78].”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [38] Inder, 2019, Participation in decision-making about medication: A qualitative analysis of medication adherence, Int. J. Ment. Health Nurs. source

      Not checked in the free run.

    • cites [56] Fiorillo, 2020, The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review, Ann. Gen. Psychiatry source

      Not checked in the free run.

    • cites [76] Gault, 2013, Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: A qualitative study, Patient Prefer. Adherence source

      Not checked in the free run.

    • cites [46] Cyr, 2013, Gaining Autonomy & Medication Management (GAM): New perspectives on well-being, quality of life and psychiatric medication, Cien. Saude Colet. source

      Not checked in the free run.

    • cites [34] Cruz, 2016, Difficulties related to medication therapy for anxiety disorder, Rev. Eletr. Enferm.

      Not checked in the free run.

    • cites [45] Xu, 2020, Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore, Arch. Psychiatr. Nurs. source

      Not checked in the free run.

    • cites [62] Velligan, 2013, A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia, Schizophr. Bull. source

      Not checked in the free run.

    • cites [77] Monterroso, 2012, Avaliação da adesão regime terapêutico dos utentes seguidos na consulta externa de psiquiatria do centro hospitalar barlavento algarvio, Rev. Port. Enferm. Saúde Ment.

      Not checked in the free run.

    • cites [78] Bolkan, 2013, Family involvement, medication adherence, and depression outcomes among patients in veterans affairs primary care, Psychiatr. Serv. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Evidence stresses the pivotal impact of therapeutic adherence on the quality of healthcare delivery, including increased demand for help and adherence to scheduled appointments, reduced rates of hospitalizations/rehospitalizations, reduction or elimination of sudden and unsupervised treatment interruptions, and decreased hospitalization costs.

    “Evidence also stresses the pivotal impact of therapeutic adherence on the quality of healthcare delivery, including increased demand for help and adherence to scheduled appointments [49], reduced rates of hospitalizations/rehospitalizations [33,61,63,70], reduction or elimination of sudden and unsupervised treatment interruptions [46], and decreased hospitalization costs [63].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [49] Sibeko, G., Temmingh, H., Mall, S., Williams-Ashman, P., Thornicroft, G., Susser, E.S., Lund, C., Stein, D.J., and Milligan, P.D. (2017). Improving adherence in mental health service users with severe mental illness in South Africa: A pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual. BMC Res. Notes, 10. source

      Not checked in the free run.

    • cites [33] Xiao, 2015, High relapse rate and poor medication adherence in the Chinese population with schizophrenia: Results from an observational survey in the People’s Republic of China, Neuropsychiatr. Dis. Treat.

      Not checked in the free run.

    • cites [61] Orsi, 2021, Evaluation of Ongoing Participation of People with Schizophrenia in a Mutual Support Group as a Complementary Intervention to Outpatient Psychiatric Treatment, Psychiatr. Q. source

      Not checked in the free run.

    • cites [63] Popp, 2014, Treatment adherence and social functioning in patients diagnosed with schizophrenia and treated with antipsychotic depot medication, Clujul Med.

      Not checked in the free run.

    • cites [70] Kirk, 2013, Adherence challenges and long-acting injectable antipsychotic treatment in patients with schizophrenia, J. Psychosoc. Nurs. Ment. Health Serv. source

      Not checked in the free run.

    • cites [46] Cyr, 2013, Gaining Autonomy & Medication Management (GAM): New perspectives on well-being, quality of life and psychiatric medication, Cien. Saude Colet. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The potential costs of boomerang effects, their causes, and their individual variations have received little consideration in extant research.

    “The potential costs of these boomerang effects, their causes, and their individual variations have received little consideration in the extant research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    Patients are frequently in emotional discomfort and overwhelmed by the information and constraints provided during the early period.

    “Patients are frequently in emotional discomfort and overwhelmed by the information and constraints provided during the early period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Rates of medication nonadherence in bipolar disorder, major depression, and schizophrenia were 44%, 50%, and 56%, respectively.

    “A recent meta-analysis found that rates of medication nonadherence in bipolar disorder, major depression, and schizophrenia were 44%, 50%, and 56%, respectively [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Semahegn, 2020, Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis, Syst. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-management is a surrogate term for therapeutic adherence, described as a basic set of skills for handling activities that an individual must perform regularly to regulate or decrease the impact of a medical condition.

    “Grady and Gough [28] suggest that self-management is a surrogate term, described as a basic set of skills for handling activities that an individual must perform on a regular basis to regulate or decrease the impact of a medical condition on their lives.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Grady, 2014, Self-management: A comprehensive approach to management of chronic conditions, Am. J. Public Health source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The concept of compliance is closely linked to strict compliance with medical prescriptions and a paternalistic doctor-patient relationship based on the patient passively following the doctor's orders.

    “This concept of compliance appears closely linked to strict compliance with medical prescriptions and a doctor-patient relationship based on the patient passively and submissively following the doctor’s orders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Treatment complexity (polypharmacy) and illness chronicity are negatively associated with nonadherence to psychopharmacological treatment.

    “Additionally, treatment complexity (polypharmacy) and illness chronicity have been identified as variables negatively associated with nonadherence to psychopharmacological treatment [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Marrero, 2020, Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review, Patient Educ. Couns. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The change in terminology from compliance to concordance was not accepted by many researchers and health professionals, leading to alternative terms such as cooperation.

    “Although this implied a new approach to the HCP-patient relationship regarding an agreement on the therapeutic regimen, the change in terminology was not accepted by many researchers and health professionals, leading to alternative terms, such as “cooperation” [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Løvsletten, M., Lossius Husum, T., Haug, E., and Granerud, A. (2020). Cooperation in the mental health treatment of patients with outpatient commitment. SAGE Open Med., 8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Therapeutic adherence is consensually accepted as fundamental for the optimal management of any disease and is interrelated to high levels of health literacy.

    “In this context, therapeutic adherence is now consensually accepted as fundamental for the optimal management of any disease and interrelated to high levels of health literacy [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Hyvert, 2022, Association between health literacy and medication adherence in chronic diseases: A recent systematic review, Int. J. Clin. Pharm. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Patients advance from one initial stage (changing) to another (growing) in their evolution and commitment to a therapeutic regimen.

    “This implies that patients advance from one initial stage (changing) to another (growing) in their evolution and commitment to a therapeutic regimen.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The six steps of Rodgers' evolutionary method of concept analysis were used to analyze the data and identify attributes, surrogate and related terms, antecedents, and consequences.

    “The six steps of Rodgers’ evolutionary method [25] of concept analysis were used to analyze the data and identify attributes, surrogate and related terms, antecedents, and consequences of the therapeutic adherence concept.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Rodgers, B.L., and Knafl, K.A. (2000). Concept Development in Nursing: Foundations, Techniques and Applications, Saunders. [2nd ed.].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The role of social pressures in non-Western societies might be due to the collectivistic ethos of these communities, which have always encouraged interconnection with others.

    “This might be due to the collectivistic ethos of these communities, which have always encouraged interconnection with others.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Western cultures are often individualistic, and people from these cultures may be more driven to behave in accordance with their own goals and views.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recovery is closely linked to the person's empowerment, described as a deeply personal process of change in attitudes, values, feelings, goals, abilities, and/or functions.

    “In this sense, recovery is closely linked to the person’s empowerment, described as a deeply personal process of change in attitudes, values, feelings, goals, abilities, and/or functions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Gronholm, 2021, Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives, Front. Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Self-reported instruments are simple to administer but may add participant bias.

    “Self-reported instruments are simple to administer but may add participant bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    During the transition between nonadherence and adherence, there may be a boomerang effect, where people choose the opposite of the HCP's indications because of how they are presented.

    “During this transition between nonadherence and adherence, there may be a boomerang effect, where people choose the opposite of the HCP’s indications because of how they are presented.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    After screening, 56 articles were deemed relevant and included in the concept analysis.

    “Following the screening procedure, 56 articles were deemed relevant and included in the concept analysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Improvements in individual motivation and readiness to change, quality of therapeutic alliance, shared decision making, community support, and quality of healthcare delivery may decrease the boomerang effect.

    “In this sense, improvements in individual motivation and readiness to change, quality of therapeutic alliance, shared decision making, community support, and quality of healthcare delivery may decrease this boomerang effect.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed in this review.

    “The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed in this review [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Page, 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, BMJ source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The philosophical perspective of person-centered care emphasizes an integrative approach where the professional, as a case manager, is central to optimizing these assumptions.

    “This philosophical perspective also emphasizes the importance of an integrative approach where the role of the professional, as a case manager, is central to the optimization of these assumptions [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Tomaselli, 2020, Person-Centered Care from a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review, Front. Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Only then will it be possible to contribute to the improvement of clinical and social outcomes, generate commitment, and guarantee a quality of services that translates into increased adherence rates and reduced number of hospitalizations and all associated costs.

    “Only then will it be possible to contribute to the improvement of clinical and social outcomes, generate commitment, and guarantee a quality of services that translates into increased adherence rates and reduced number of hospitalizations and all associated costs (including pharmacy costs and inpatient and outpatient costs) [91].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Cutler, 2018, Economic impact of medication non-adherence by disease groups: A systematic review, BMJ Open source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The lack of understanding of subjective norms and perceived social pressures might be attributed to variations in cultural norms and beliefs.

    “This might be attributed to variations in cultural norms and beliefs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Western cultures are often individualistic, and people from these cultures may be more driven to behave in accordance with their own goals and views.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Recovery is a way of living a life of satisfaction, hope, and contribution.

    “It is a way of living a life of satisfaction, hope, and contribution [85].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Gronholm, 2021, Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives, Front. Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    People living with a chronic mental illness who require medication and psychotherapeutic interventions on a regular basis might gain experience in daily self-management (evolving).

    “This also supports the hypothesis that people living with a chronic mental illness who require medication and psychotherapeutic interventions on a regular basis might gain experience in daily self-management (evolving).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Overall, the concept analysis findings support person-centered care, highlighting increased empowerment of people with mental illness integrated into their biopsychosocial and cultural context.

    “Overall, our findings support the notion of person-centered care, highlighting the increased empowerment of people with mental illness, integrated into their biopsychosocial and cultural context [81,82,83].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [81] Miller, 2017, Person-centered planning in mental health: A transatlantic collaboration to tackle implementation barriers, Am. J. Psychiatr. Rehabil. source

      Not checked in the free run.

    • cites [82] Poitras, M.E., Maltais, M.E., Bestard-Denommé, L., Stewart, M., and Fortin, M. (2018). What are the effective elements in patient-centered and multimorbidity care? A scoping review. BMC Health Serv. Res., 18. source

      Not checked in the free run.

    • cites [83] Boardman, 2020, Person-centred care and psychiatry: Some key perspectives, BJPsych. Int. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Improving competencies in motivational techniques, empowerment, and hope management might be crucial to help patients grow and change.

    “Improving competencies in motivational techniques, empowerment, and hope management might be crucial to help patients grow and change [87,88].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [87] Hardcastle, 2015, Motivating the unmotivated: How can health behavior be changed in those unwilling to change?, Front. Psychol. source

      Not checked in the free run.

    • cites [88] Laranjeira, 2022, Hope and Optimism as an Opportunity to Improve the “Positive Mental Health” Demand, Front. Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Connection and alliance with patients allow them to better understand their symptoms and achieve therapeutic adherence, which in turn helps stabilize their symptoms and reduce the burden on family members.

    “Connection and alliance with patients allow them to better understand their symptoms and achieve therapeutic adherence, which in turn helps stabilize their symptoms and reduce the burden on family members [89].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] McAllister, 2019, Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review, Int. J. Nurs. Stud. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The diversity of the included literature reinforces the applicability of the conclusions across a wide range of scenarios.

    “The diversity of this literature reinforces the applicability of our conclusions across a wide range of scenarios.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    All the mentioned tools were used to rate adherence to medication, which narrows the multidimensional assessment of therapeutic adherence.

    “All the mentioned tools were used to rate adherence to medication that narrows the multidimensional assessment of therapeutic adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Social effects often explain the public stigma surrounding mental health illnesses, which hampers people's intent to seek assistance and adhere to therapy regimens for fear of social rejection.

    “Thus, social effects often explain the public stigma surrounding mental health illnesses, which hampers people’s intent to seek assistance and adhere to therapy regimens for fear of social rejection [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Adams, 2022, Explaining adults’ mental health help-seeking through the lens of the theory of planned behavior: A scoping review, Syst. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Mental health nursing interventions that address the dynamic process of adherence can be designed to assist patients in achieving a seamless transition throughout stages (from nonadherence to adherence).

    “Although adherence to therapy is sensitive to different disciplinary areas, mental health nursing interventions that address the dynamic process of adherence can be designed to assist patients in achieving a seamless transition throughout stages (from nonadherence to adherence).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    This framework emphasizes the complexities of therapeutic adherence in the context of mental health and illustrates its dynamic capacity to span many disciplines.

    “This framework emphasizes the complexities of therapeutic adherence in the context of mental health and illustrates its dynamic capacity to span many disciplines.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Only two databases were used, and relevant papers may have been missed.

    “First, although the search was systematic, only two databases were used, and relevant papers may have been missed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Several factors could contribute to the boomerang effect opposing the intended intervention: when message content is too far removed from the patient's position; when no good arguments are contained in a delivered message; when patients anticipate that the conclusions will be contrary to their interests; and when communication induces emotional arousal and aggressive behavior.

    “Several factors could contribute to this negative effect, namely: (a) when the message content is too far removed from the patient’s position, (b) when no good arguments are contained in a delivered message, (c) when the patients anticipate that the conclusions will be contrary to their interests, and (d) when communication induces emotional arousal and aggressive behavior [92].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Byrne, 2009, The Boomerang Effect A Synthesis of Findings and a Preliminary Theoretical Framework, Ann. Int. Commun. Assoc.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Rodgers' suggestion to include 30 papers or 20% from each area in the study could not be implemented.

    “Thus, Rodgers’ [15] suggestion to include 30 papers or 20% from each area in the study could not be implemented.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Tofthagen, 2010, Rodgers’ evolutionary concept analysis-a valid method for developing knowledge in nursing science, Scand. J. Caring Sci. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    The systematic structure of the concept analysis facilitates the use of results by stakeholders interested in applying the findings to healthcare policy and practice.

    “However, its systematic structure facilitates the use of results by stakeholders interested in applying the findings to healthcare policy and practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Improving adherence can improve therapeutic efficacy, clinical practice development, medical expenses, and patient safety.

    “Improving adherence can improve therapeutic efficacy, clinical practice development, medical expenses, and patient safety.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Since MHNs have the most direct contact with patients, they play a critical role in ensuring that patients adhere to long-term therapy.

    “Since MHNs have the most direct contact with patients, they play a critical role in ensuring that patients adhere to long-term therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Inviting patients who are successful in self-management to share their experiences can help patients who are new to the dynamic process of adherence and boost the self-esteem of those who have been through it.

    “This can help patients who are new to the dynamic process of adherence and boost the self-esteem of those who have been through it.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Within the current literature, the findings imply a comprehensive definition of therapeutic adherence addressing a holistic picture of the patient and their circumstances.

    “Within the current literature, the findings imply a comprehensive definition of therapeutic adherence addressing a holistic picture of the patient and their circumstances.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    When all the attributes are present in therapeutic adherence behavior-individual, microsystem, and meso/exosystem levels-the full meaning of the concept is translated into a comprehensive care practice.

    “When all the attributes are present in therapeutic adherence behavior—individual, microsystem, and meso/exosystem levels—the full meaning of the concept is translated into a comprehensive care practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Only adult patients and papers published in English or Portuguese were studied.

    “Finally, only adult patients and papers published in English or Portuguese were studied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Afterward, patients tend to practice their own level of adherence to living with mental health conditions, exhibiting personal improvement.

    “Afterward, patients tend to practice their own level of adherence to living with mental health conditions, exhibiting personal improvement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationcitation

    Therapeutic adherence is expected to improve in patients with mental illnesses who typically require supervision and close help, as community-based services are increasingly strengthened.

    “Therapeutic adherence is expected to improve in patients with mental illnesses who typically require supervision and close help, as community-based services are increasingly strengthened.”
    Quote in the paperNot a substantial claim
50 of 50

  • The paper relies on this without support.

    There is still a lack of conceptual clarity regarding the terms 'adherence', 'compliance', and 'self-management' in the literature.

    “Despite decades of using the terms “adherence”, “compliance”, and “self-management” in the literature, there is still a lack of conceptual clarity.”

  • The paper relies on this without support.

    The microsystem, meso/exosystem, and macrosystem levels have not been studied as thoroughly as patient-level issues.

    “Nonetheless, the last three levels have not been studied as thoroughly as patient-level issues.”

  • The paper relies on this without support.

    Therapeutic nonadherence remains a serious public health problem.

    “Despite the recognized importance of adherence and the scientific community’s great attention in recent decades, nonadherence remains a serious public health problem, linked more to the economic costs of the disease than just the associated human costs.”

  • The paper relies on this without support.

    Adherence to a prescribed therapeutic regimen is impacted not just by the patient's individual features but also by variables in the patient's environment or system-level factors.

    “Adherence to a prescribed therapeutic regimen is impacted not just by the patient’s individual features but also by variables in the patient’s environment or so-called system-level factors.”

  • The paper relies on this without support.

    Western cultures are often individualistic, and people from these cultures may be more driven to behave in accordance with their own goals and views.

    “Western cultures, for example, are often individualistic, and people from these cultures may be more driven to behave in accordance with their own goals and views.”

  • The authors state this as an assumption.

    A person's culture and contextual history will influence how they perceive mental illness, therapy, and engagement with the treatment team.

    “While the macrosystem is still unclear, we assume that a person’s culture and contextual history will influence how they perceive mental illness, therapy, and engagement with the treatment team.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The group-based and online format may facilitate accessibility, continuity of care after discharge, and adherence to treatment, which are common challenges in suicide prevention programmes.

    “The group-based and online format may facilitate accessibility, continuity of care after discharge, and adherence to treatment, which are common challenges in suicide prevention programmes [81].”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [81]

    The Results (section 3.2, page unavailable) identify telehealth, community groups, service availability, continuity of care, and discharge planning as factors relevant to therapeutic adherence. The exemplar case (section 3.6, page unavailable) describes teleconsultation alongside continuity and adherence. The paper does not establish that a group-based online format addresses these challenges specifically in suicide prevention programmes. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Six related terms are described as four

    Minor

    The sentence says the search found four related terms, but it lists six: compliance, concordance, cooperation, maintenance, commitment, and engagement.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Christensen, A.J. (2004). Patient Adherence to Medical Treatment Regimens: Bridging the Gap Between Behavioral Science and Biomedicine, Yale University Press.
  2. Rodgers, B.L., and Knafl, K.A. (2000). Concept Development in Nursing: Foundations, Techniques and Applications, Saunders. [2nd ed.].
  3. Cruz, 2016, Difficulties related to medication therapy for anxiety disorder, Rev. Eletr. Enferm., 18, e1155
  4. Campos, 2017, Narratives of users of mental health services in an experiment with autonomous management of medication, Cad. Saude Publica, 33, e00166216
  5. Malvezzi, 2016, Adherence to treatment by the staff of a mental health service: An exploratory study, Online Braz. J. Nurs., 15, 177

Cited by

Sorted by citations

Related

Authors
Laranjeira, C., Carvalho, D., Valentim, O., Moutinho, L., Morgado, T., Tomás, C., Gomes, J., & Querido, A.
Affiliations
  • Universidade de Leiria e Oeste (PT)
  • Group Innovation & Development in Nursing (NursID), Center for Health Technology and Services Research (CINTESIS@RISE), 4200-450 Porto, Portugal
Corresponding author
Laranjeira, Carlos
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2023-02-22
Volume
20
Issue
5
Pages
3869
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph20053869
PMC
PMC10001153
OpenAlex
W4321497317
Semantic Scholar
3836e99c7f18220fbc692da22d3139432c356583
Cited by
45
References
86
Citations by year
2026: 18 · 2025: 17 · 2024: 6 · 2023: 4
FWCI
2.09
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Funders
  • FCT—Fundação para a Ciência e a Tecnologia (UIDB/05704/2020, UIDP/05704/2020, CEECINST/00051/2018)
  • Scientific Employment Stimulus-Institutional Call (UIDB/05704/2020, UIDP/05704/2020, CEECINST/00051/2018)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
medication adherence, mental illness, patient engagement, treatment commitment, ecological systems theory, conceptual definitions
MeSH terms
Mental Disorders, Concept Formation, Humans, Mental Health, Patient Compliance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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