Citation

Senteio C, Veinot T. Qual. Health Res. 2014; 24(12): 1745-1756.

Affiliation

University of Michigan, Ann Arbor, Michigan, USA tveinot@umich.edu.

Copyright

(Copyright © 2014, SAGE Publishing)

DOI

10.1177/1049732314549027

PMID

25212857

Abstract

Adherence to treatment recommendations for chronic diseases is notoriously low across all patient populations. But African American patients, who are more likely to live in low-income neighborhoods and to have multiple chronic conditions, are even less likely to follow medical recommendations. Yet we know little about their contextually embedded, adherence-related experiences. We interviewed individuals (n = 37) with at least two of the following conditions: hypertension, diabetes, and chronic kidney disease. Using an "invisible work" theoretical framework, we outline the adherence work that arose in patients' common life circumstances. We found five types: constantly searching for better care, stretching medications, eating what I know, keeping myself alive, and trying to make it right. Adherence work was effortful, challenging, and addressed external contingencies present in high-poverty African American neighborhoods. This work was invisible within the health care system because participants lacked ongoing, trusting relationships with providers and rarely discussed challenges with them.

Language: en