According to the World Health Organization (8), adherence can be defined as "the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider." The term "compliance" is often used synonymously with "adherence," but often criticized as having coercive and paternalistic connotations (9,10). By contrast, adherence is viewed as an intentional act of commitment to health care that has been agreed by both patient and provider.
Distinct from the concept of adherence is concordance. Whereas adherence focuses upon the adolescent's behavior in accordance with the health professional's recommendations for treatment, concordance is much more concerned with the process of consultation. While most commonly used in relation to prescribing and medicine taking (11), concordance is based upon shared decision-making in which both patient and provider are considered to have different, but equally important expertise. A concordant consultation is therefore one in which the adolescent, their parents, and health professionals all work together to agree when, how, and why the illness should be managed (12,13). Shared decision-making has certainly been identified as an integral part of best practice by adolescents with chronic rheumatic diseases (14) and rheumatology providers (15). However, the concept of concordance is a new one, and while gaining interest in the literature, there is little evaluative research on the impact of this on patient outcome, not least among adolescents with chronic rheumatic diseases. Adherence is therefore the preferred term to be used in this chapter. At this point, it is perhaps important to note that poor adherence can be intentional or involuntary (12). Adolescents face many barriers that may hinder their adherence. However adolescents can also differ from health professionals in their goals for treatment and beliefs about efficacy. Thus, adolescent perceived as non-adherent to a prescribed recommendation may, in fact, be fully adherent to a regimen that they themselves have chosen.
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