title: Trying to make things right: adherence work in high-poverty, African American neighborhoods.
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.
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Senteio
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA tveinot@umich.edu.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Veinot
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000628:therapy*; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D011204:Poverty Areas; D036301:Qualitative Research; D014481:United States; D014505:Urban Population
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