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Qual Health Res. 2014 Dec;24(12):1745-56. doi: 10.1177/1049732314549027. Epub 2014 Sep 11.

Trying to make things right: adherence work in high-poverty, African American neighborhoods.

Author information

1
University of Michigan, Ann Arbor, Michigan, USA.
2
University of Michigan, Ann Arbor, Michigan, USA tveinot@umich.edu.

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.

KEYWORDS:

African Americans; adherence; communication; emotions / emotion work; grounded theory; health and well-being; health behavior; illness and disease, chronic; illness and disease, experiences; motivation; poverty; psychosocial issues; relationships, patient–provider; self-care; urban issues

PMID:
25212857
DOI:
10.1177/1049732314549027
[Indexed for MEDLINE]

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