Trying to make things right: adherence work in high-poverty, African American neighborhoods

Qual Health Res. 2014 Dec;24(12):1745-56. doi: 10.1177/1049732314549027. Epub 2014 Sep 11.


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.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans*
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Diabetes Mellitus / ethnology
  • Diabetes Mellitus / therapy*
  • Female
  • Humans
  • Hypertension / ethnology
  • Hypertension / therapy*
  • Interviews as Topic
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Motivation
  • Patient Compliance*
  • Poverty Areas*
  • Qualitative Research
  • United States
  • Urban Population