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

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 fiv...

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Detalles Bibliográficos
Autores principales: Hawking, Meredith K. D., Robson, John, Taylor, Stephanie J. C., Swinglehurst, Deborah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649927/
https://www.ncbi.nlm.nih.gov/pubmed/32856537
http://dx.doi.org/10.1177/1049732320951772
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author Hawking, Meredith K. D.
Robson, John
Taylor, Stephanie J. C.
Swinglehurst, Deborah
author_facet Hawking, Meredith K. D.
Robson, John
Taylor, Stephanie J. C.
Swinglehurst, Deborah
author_sort Hawking, Meredith K. D.
collection PubMed
description 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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spelling pubmed-76499272020-11-23 Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication Hawking, Meredith K. D. Robson, John Taylor, Stephanie J. C. Swinglehurst, Deborah Qual Health Res Research Articles 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. SAGE Publications 2020-08-28 2020-12 /pmc/articles/PMC7649927/ /pubmed/32856537 http://dx.doi.org/10.1177/1049732320951772 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Research Articles
Hawking, Meredith K. D.
Robson, John
Taylor, Stephanie J. C.
Swinglehurst, Deborah
Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title_full Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title_fullStr Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title_full_unstemmed Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title_short Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication
title_sort adherence and the moral construction of the self: a narrative analysis of anticoagulant medication
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649927/
https://www.ncbi.nlm.nih.gov/pubmed/32856537
http://dx.doi.org/10.1177/1049732320951772
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