Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication

Abstract

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.

The Experience of Taking Medication to Prevent a Further Heart Attack: An Interpretative Phenomenological Analysis

“…The theme of comparison to others and seeing one's own health protective behaviours as superior to others, could be construed as participants' way of evidencing their own health, maintaining control, and/or providing self-reassurance. This theme of comparison to others was also discussed in a narrative analysis of patients taking anticoagulant medicines to prevent stroke [26]. In that study, participants also constructed themselves as superior to others, evidencing their good intentions for example as good adherers while non-adherers were 'wasteful' or 'ungrateful'.…”

Organising polypharmacy: unpacking medicines, unpacking meanings—an ethnographic study

“…The effort required by patients to do this work, and patients’ capacity to do it are rarely discussed in formal processes of medication review. This work includes: practical acts of organising; surveillance of self and supplies; creative workarounds and experimentation with prescribed regimens; evaluation and management of personal priorities; anticipation and preparedness; management of self-presentation, itself a form of ‘moral’ work that includes the presentation of self as a ‘good’ adherent patient 35 ; and securing the collaboration of carers and other professionals.…”

An Interpretative Phenomenological Analysis of the Experience of Taking Medication to Prevent a Further Heart Attack

“…A semi-structured interview schedule was used to guide the interviews. The schedule was informed by one used in a similar medicine adherence phenomenological study [21], and more general literature on developing interview protocol [22]. Following the rst interview, the schedule was re ned in accordance with a self-re ective 'interview the interviewer' technique [23], the nal schedule can be found in Additional Information.…”