Background Medicines adherence is a significant, global problem presenting challenges across populations as well as on an individual patient level. Medicines non-adherence has consequences on social, biological and economical outcomes of the health service. Although there is a plethora of research investigating adherence to develop interventions to improve adherence, a recent Cochrane Review concluded that there was insufficient evidence of the efficacy of adherence interventions to date. Additionally there is on-going conflict about the definition of adherence and how it can be measured across different disease states. The aim of our research is to deliver key insights into the experience of medicines adherence in men with diabetes using transcendental phenomenology to describe the essential textural and structural aspects of adherence.
Methods Participants were convenience sampled and recruited through community pharmacy and general medical practice. Interviews took place in patients’ homes, the university and public locations. Eight qualitative semi-structured interviews were audio-recorded, transcribed and thematically analysed (by hand and QSR NVivo10).
Results The themes identified were i) experimentation ii) function iii) construction/personalisation and iv) habituation. Patients in the study reported experiencing a period of fear of death and disablement when they were first prescribed a medicine. This led to experimentation with medicines socially (socialisation as a ‘tablet taker’) and symptomatically (relating symptoms to adherence). Patients initially felt that experimental non-adherence was ‘naughty’ but that this deviance could be sanctioned through increased socialisation with healthcare practitioners, family and friends. Patients experimented with adherence as a functional phenomenon; adherence appeared to have latent and manifest functions, resulting in a constructed personalisation of adherence. Patients also reported an aspect of adherence as habitual; a task-based, easy, outcome-driven phenomenon. Taking medicines appeared not to be about adherence to the prescription but adherence to a socially normalised tool for survival; functionalised, personalised and habituated through time, exposure and experience.
Conclusion In essence; adherence is an intrinsically personal yet socially-enforced phenomenon which exists manifestly as a procedure of symptom-management and latently as a normalised habit of survival. Interventions to improve adherence in men with diabetes might emphasise a process of personalisation to facilitate the habituation of adherence, rather than non-adherence. A limitation of recruitment meant that only patients accessing pharmacy or GP services were involved in the study; excluding a set of arguably non-adherent patients. This study is not generalizable but may be transferable to other contexts. The study has the potential for impact, as it recognises that adherence, despite years of research, is still predominantly understood as a bio-medical phenomenon, and presents a novel, phenomenological approach to understanding adherence in a hard to reach group.
- medicines adherence