Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication.
Meredith K D HawkingJohn RobsonStephanie J C TaylorDeborah SwinglehurstPublished in: Qualitative health research (2020)
In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as "good" and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016-June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.
Keyphrases
- atrial fibrillation
- end stage renal disease
- healthcare
- ejection fraction
- chronic kidney disease
- newly diagnosed
- emergency department
- peritoneal dialysis
- venous thromboembolism
- primary care
- type diabetes
- heart failure
- mental health
- risk assessment
- metabolic syndrome
- patient reported outcomes
- decision making
- health information
- percutaneous coronary intervention
- acute coronary syndrome
- case report
- insulin resistance
- catheter ablation
- skeletal muscle
- mitral valve
- patient reported
- medical students
- subarachnoid hemorrhage
- electronic health record