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.

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.

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