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Mendoza JA, Lasco G, Renedo A, Palileo-Villanueva L, Seguin M, Palafox B, Amit AML, Pepito V, McKee M, Balabanova D. (De)constructing 'therapeutic itineraries' of hypertension care: A qualitative study in the Philippines. Soc Sci Med 2022; 300:114570. [PMID: 34802782 PMCID: PMC7613024 DOI: 10.1016/j.socscimed.2021.114570] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as 'pre-diagnosis' (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.
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Affiliation(s)
- Jhaki A Mendoza
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines.
| | - Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, 1111, Philippines
| | - Alicia Renedo
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - Maureen Seguin
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines Manila, Manila, Philippines; School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Veincent Pepito
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Dina Balabanova
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Hawking MKD, Robson J, Taylor SJC, Swinglehurst D. Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication. QUALITATIVE HEALTH RESEARCH 2020; 30:2316-2330. [PMID: 32856537 PMCID: PMC7649927 DOI: 10.1177/1049732320951772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as "good" and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016-June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.
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Affiliation(s)
- Meredith K. D. Hawking
- Queen Mary University of London, London, United Kingdom
- Meredith K. D. Hawking, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK.
| | - John Robson
- Queen Mary University of London, London, United Kingdom
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Abstract
This review discusses a growing body of scholarship at the intersection of anthropology and science and technology studies (STS) that examines how drugs are rendered efficacious in laboratories, therapeutic settings, and everyday lives. This literature foregrounds insights into how commercial interests and societal concerns shape the kinds of pharmaceutical effects that are actualized and how some efficacies are blocked in response to moral concerns. The work brought together here reveals how regulatory institutions and health policy makers seek to stabilize pharmaceutical actions while, on the front lines of care, pharmacists, health workers, and users tinker with dosages and indications to tailor pharmaceutical actions to specific circumstances. We show that there is no pure (pharmaceutical) object that precedes its socialization. Pharmaceuticals are not “discovered”; they are made and remade in relation to shifting contexts. This review outlines five key areas of ethnographic and STS research that examines such fluid drugs.
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Affiliation(s)
- Anita Hardon
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam 1001 NA, Netherlands
| | - Emilia Sanabria
- Laboratoire d'Anthropologie des Enjeux Contemporains (LADEC), École Normale Supérieure de Lyon, 69364 Lyon, France
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