Rethinking decision-making in the context of preventive medication: How taking statins becomes “the right thing to do”

Polak, Louisa; Green, John

doi:10.1016/j.socscimed.2020.112797

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Interviewees' accounts were different from those who took part in AF screening who sometimes struggled to articulate exactly why they did so, as inherently obvious as it was to engage in screening. 34 This echoes Polak and Green's 59 preventative medication decision-making study: while statin-takers presented 'no-choice' but to take them, nontakers stressed their need to 'think about it', prioritising their concerns about medication sideeffects to explain their decision to deviate from a clinicianendorsed approach. Across both studies, those taking part and HOARE ET AL.…”

Section: Box 2 Summary Of Interview Topic Guidementioning

confidence: 96%

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Hoare

Thomas

Powell

et al. 2023

Health Expectations

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IntroductionWhile screening uptake is variable, many individuals feel they ‘ought’ to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration.MethodsWe explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population‐based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically.ResultsBeyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary—something they could legitimately decline.ConclusionNonparticipants were not resistant to engaging in health‐promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part.Patient or Public ContributionThe SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co‐applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.

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Section: Box 2 Summary Of Interview Topic Guidementioning

confidence: 96%

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Hoare

Thomas

Powell

et al. 2023

Health Expectations

View full text Add to dashboard Cite

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“…Critics have raised concerns that existing self-management programmes often pay little attention to the social factors shaping the lives of the intended recipients, and instead the programmes themselves become a source of inner conflict and stress for patients (Audulv et al, 2012;McDonald et al, 2016). Increasingly self-management research suggests that much of the 'work' of living with LTCs is collaborative (Polak & Green, 2020). Existing research, typically focused on English-speaking patients with specific diseases, highlights the importance of family networks in managing the burdens of LTCs (Boise et al, 1996) .…”

Section: Introductionmentioning

confidence: 99%

“…Increasingly, self-management research suggests that much of the “work” of living with LTCs is collaborative ( Polak & Green, 2020 ). Existing research, typically focused on English-speaking patients with specific diseases, highlights the importance of family networks in managing the burdens of LTCs ( Boise et al, 1996 ).…”

Section: Introductionmentioning

confidence: 99%

Self-Management in Older Pakistanis Living With Multimorbidity in East London

Sultan

Swinglehurst

2021

Qual Health Res

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In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of “managing” in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.

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“…Patients are framed as active partners in their care, and the emphasis shifts toward facilitating patient choice (including treatment refusal), and reducing blame ( NICE, 2009 ). In practice, however, medication adherence is often indistinct from compliance ( Trnka, 2014 ), and critics have long argued for alternative conceptions of medicine-taking that more accurately account for patient agency, social context, meaning making, and experience ( Britten, 1996 ; Chamberlain et al, 2011 ; Conrad, 1985 ; Dew et al, 2014 ; Donovan & Blake, 1992 ; Drabble et al, 2019 ; Huyard et al, 2017 , 2019 ; Lumme-Sandt et al, 2000 ; McCoy, 2009 ; Murdoch et al, 2014 ; Polak, 2017 ; Polak & Green, 2020 ; Pound et al, 2005 ; Shoemaker & Ramalho de Oliveira, 2008 ; Webster et al, 2009 ; Werremeyer et al, 2017 ). For example, “medicines resistance” captures the creative, hidden work that patients undertake to minimize, modify, and resist medication intake ( Chamberlain et al, 2011 ; Murdoch et al, 2013 ; Pound et al, 2005 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Rethinking decision-making in the context of preventive medication: How taking statins becomes “the right thing to do”

Cited by 6 publications

References 36 publications

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Self-Management in Older Pakistanis Living With Multimorbidity in East London

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

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