Intentional Nonadherence as a Means to Exert Control

Abstract

Medication adherence is a major issue for patients with a chronic illness, who sometimes rationally choose temporary nonadherence. This study aims at better understanding intentional nonadherence and especially why it seems to fluctuate over time. It is based on 48 semi-structured interviews conducted in a hospital in the Netherlands with patients who had been prescribed a medication for a chronic disease for at least 1 year, and who had either type 2 diabetes, hypertension, Parkinson's disease, inflammatory bowel disease, or chronic myeloid leukemia. The analysis uses a simplified version of the failure modes and effects analysis (FMEA) method. Intentional nonadherence appeared to be the result of the respondents' desire (a) to exert control over the treatment and its effects on their body, and (b) to control the hold of the treatment on their daily life. This result provides a rationale for the fluctuation of intentional nonadherence behavior.

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

“…However, a relevant proportion of patients do not stop taking medications because they feel worse but because they feel better. Given the plethora of reasons for intentional nonadherence, an individual approach is necessary to positively modulate adherence in elderly people with PD (31,32). Because many people discontinue medication because of side effects, comprehensive education on side effects and what to do in case of side effects is recommended for every patient.…”

“…We also found that patients with motor complications (higher MDS-UPDRS IV), which frequently occur in advanced disease stages, tended to demonstrate intentional nonadherence by modifying their prescribed medication. This was probably the result of patients' desire to exert control over the treatment and its effects on their bodies (31). Higher motor problems and the consequent higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication.…”

‘In the hospital all is taken care of’: a practice‐theoretical approach to understand patients’ medication use

“…Conceptions of patients’ medication use that focus on individual behaviour and patient characteristics have been criticised for having an overly narrow and medically centred orientation (Conrad ), a criticism reiterated in different treatment contexts (Huyard et al . , Lutfey Spencer ). Also, approaches targeting individual medication‐taking behaviour have shown limited effectiveness in terms of improved health outcomes (Nieuwlaat et al .…”

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

“…Patients are framed as active partners in their care, and the emphasis shifts toward facilitating patient choice (including treatment refusal), and reducing blame ( NICE, 2009 ). In practice, however, medication adherence is often indistinct from compliance ( Trnka, 2014 ), and critics have long argued for alternative conceptions of medicine-taking that more accurately account for patient agency, social context, meaning making, and experience ( Britten, 1996 ; Chamberlain et al, 2011 ; Conrad, 1985 ; Dew et al, 2014 ; Donovan & Blake, 1992 ; Drabble et al, 2019 ; Huyard et al, 2017 , 2019 ; Lumme-Sandt et al, 2000 ; McCoy, 2009 ; Murdoch et al, 2014 ; Polak, 2017 ; Polak & Green, 2020 ; Pound et al, 2005 ; Shoemaker & Ramalho de Oliveira, 2008 ; Webster et al, 2009 ; Werremeyer et al, 2017 ). For example, “medicines resistance” captures the creative, hidden work that patients undertake to minimize, modify, and resist medication intake ( Chamberlain et al, 2011 ; Murdoch et al, 2013 ; Pound et al, 2005 ).…”