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Finnikin S, Finney B, Khatib R, McCormack J. Statins, risk, and personalised care. BMJ 2024; 384:e076774. [PMID: 38499292 DOI: 10.1136/bmj-2023-076774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Sam Finnikin
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | | | - Rani Khatib
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - James McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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Liyanagunawardena S. Wrangling for health: Moving beyond 'tinkering' to struggling against the odds. Soc Sci Med 2023; 320:115725. [PMID: 36716695 DOI: 10.1016/j.socscimed.2023.115725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
This article proposes and outlines a new metaphor - 'wrangling for health'- to think about the health seeking efforts occurring within the complex and exhausting everyday realities of resource-poor communities. It draws on fieldwork carried out in a rural community in Sri Lanka (in 2019) with the aim of generating data on the therapeutic practices and health seeking activities of 20 households in the face of everyday ill-health matters. For people in such resource-poor communities, achieving a 'good' health outcome(s) means a constant and ongoing struggle against the challenges of a low-income household, inhospitable healthcare settings and a diverse therapeutic landscape. Based on my findings, I present four key trends in this struggle: a) negotiating the costs and economies of healthcare, b) seeking treatment only as a desperate measure, c) navigating the diverse therapeutic alternatives and d) circumventing the system. These give a glimpse into the ongoing and painstaking efforts by which people creatively mobilise and manipulate whatever resources accessible to them, balance the pros and cons of potential outcome(s) and persevere courageously against adverse circumstances. As such, the struggle for health mirrors their ongoing struggle to 'tie it up together' or wrangle it in everyday life ("jeewithaya gatagaha-gannava"). Wrangling for health - in its sense of struggling against the odds - is therefore proposed as a metaphor for health engagements that challenge the notion of 'tinkering' (Mol, 2008; Mol et al., 2015) so as to depict more accurately the broad range of health seeking efforts that occur within the diverse healthcare landscapes around the world.
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Pacyna JE, Ennis JS, Kullo IJ, Sharp RR. Examining the Impact of Polygenic Risk Information in Primary Care. J Prim Care Community Health 2023; 14:21501319231151766. [PMID: 36718804 PMCID: PMC9893392 DOI: 10.1177/21501319231151766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Polygenic risk testing examines variation across multiple genes to estimate a risk score for a particular disease, including risk scores for many common, chronic health conditions. Although polygenic risk information (PRI) may be a promising tool for enhancing preventive counseling and facilitating early identification of disease, its potential impact on primary-care encounters and disease prevention efforts has not been well characterized. METHODS We conducted in-depth, semi-structured interviews of patients to assess their understandings of PRI and their beliefs about its relevance to disease prevention. RESULTS We completed interviews with 19 participants. Participants described enthusiasm for the generation of PRI and recognized its utility for disease prevention. Participants also described the value of PRI as limited if not corroborated by non-genetic risk factors. Finally, participants noted that PRI, by itself, would be insufficient as a trigger for initiating many preventive interventions. CONCLUSION PRI has the potential to become an important tool in primary care. However, patient views about PRI as well as the complexities of disease prevention in the primary care context may limit the impact of PRI on disease prevention.
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Affiliation(s)
- Joel E. Pacyna
- Biomedical Ethics Program, Mayo Clinic,
Rochester, MN, USA
| | | | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine,
Mayo Clinic, Rochester, MN, USA
| | - Richard R. Sharp
- Biomedical Ethics Program, Mayo Clinic,
Rochester, MN, USA
- Department of Quantitative Health
Sciences, Mayo Clinic, Rochester, MN, USA
- Center for Individualized Medicine,
Mayo Clinic, Rochester, MN, USA
- Richard R. Sharp, Biomedical Ethics
Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Experiences of Patients Taking Conditioned Open-Label Placebos for Reduction of Postoperative Pain and Opioid Exposure After Spine Surgery. Int J Behav Med 2022:10.1007/s12529-022-10114-5. [PMID: 35915346 DOI: 10.1007/s12529-022-10114-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pain after spine surgery is difficult to manage, often requiring the use of opioid analgesics. While traditional "deceptive" or concealed placebo has been studied in trials and laboratory experiments, the acceptability and patient experience of taking honestly prescribed placebos, such as "open-label" placebo (non-deceptive placebo), or conditioned placebo (pairing placebo with another active pharmaceutical) is relatively unexamined. METHODS Qualitative thematic analysis was performed using semi-structured, post-treatment interviews with spine surgery patients (n = 18) who had received conditioned open-label placebo (COLP) during the first 2-3 weeks after surgery as part of a RCT. Interview transcripts were reviewed by 3 investigators using an immersion/crystallization approach, followed by iterative large-group discussions with additional investigators, to identify, refine, and codify emergent themes. RESULTS Patients' experiences and perceptions of COLP efficacy varied widely. Some emergent themes included the power of the mind over pain, how COLP might provide distraction from or agency over pain, bandwidth required and engagement with COLP, and its modulation of opioid tapering, as well as negative attitudes toward opioids and pill taking in general. Other themes included uncertainty about COLP efficacy, observations of how personality may relate to COLP efficacy, and a recognition of the greater impact of COLP on reduction of opioid use rather than on pain itself. Interestingly, participant uncertainty, disbelief, and skepticism were not necessarily associated with greater opioid consumption or worse pain. CONCLUSION Participants provided insights into the experience of COLP which may help to guide its future utilization to manage acute pain and tapering from opioids.
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What factors influence engagement with primary mental health care services? A qualitative study of service user perspectives in rural communities of Mexico. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hultberg J, Nilsson S, Rudebeck CE, Köhler AK. Dealing with being prescribed cardiovascular preventive medication: a narrative analysis of qualitative interviews with patients with recent acute coronary heart disease in Sweden. BMJ Open 2021; 11:e056677. [PMID: 34921090 PMCID: PMC8685966 DOI: 10.1136/bmjopen-2021-056677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To explore how patients with experience of acute coronary heart disease make sense of, and deal with, the fact of being prescribed cardiovascular preventive medication. DESIGN Qualitative interview study. SETTING Swedish primary care. PARTICIPANTS Twenty-one participants with experience of being prescribed cardiovascular preventive medication, recruited from a randomised controlled study of problem-based learning for self-care for coronary heart disease. METHODS The participants were interviewed individually 6-12 months after their hospitalisation for acute coronary disease. A narrative analysis was conducted of their accounts of being prescribed cardiovascular preventive medication. RESULTS Four themes shape the patients' experiences: 'A matter of living' concerns an awareness of the will to live linked to being prescribed cardiovascular preventive medication regarded in the light of the recent hospitalisation. In 'Reconciliation of conflicting self-images', patients dealt with being prescribed preventive medication through work to restore an identity of someone responsible in spite of viewing the taking of medication as questionable. The status of feeling healthy, while being someone in need of medication, also constituted conflicting self-images. Following this, taking medication was framed as necessary, not as an active choice. 'Being in the hands of expertise' is about the seeking of an answer from a reliable prescriber to the question: 'Is this medication really necessary for me?' Existential labour was done to establish that the practice of taking cardiovascular preventive medication was an inevitable necessity, rather than an active choice. 'Taking medicines no longer a big deal' could be the resulting experience of this process. CONCLUSIONS Unmet existential needs when being prescribed cardiovascular preventive medication seem to be a component of the burden of treatment. A continuous and trustful relationship with the prescribing doctor may facilitate the reconciliation of conflicting self-images, and support patients in their efforts to incorporate their medicines taking into daily life.
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Affiliation(s)
- Josabeth Hultberg
- Åby Primary Health Care Centre, SE-616 21 Åby, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Staffan Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | | | - Anita Kärner Köhler
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Douglass T, Calnan M. The Disparate Approaches of General Practitioners to the Pharmaceuticalisation of Cardiovascular Disease Prevention. FRONTIERS IN SOCIOLOGY 2021; 6:650997. [PMID: 34095288 PMCID: PMC8176921 DOI: 10.3389/fsoc.2021.650997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
In the context of current clinical practice guidance, this paper will analyse the role of GPs in decision-making about the primary prevention of cardiovascular disease (CVD) using the concept of pharmaceuticalisation. Drawing on thematic analysis of semi-structured interviews with 20 GPs, the paper argues that the way GPs approach CVD pharmaceuticalisation is shaped by their understandings of and use of guidelines (and the knowledge they embody), existing treatment perspectives and the moral qualities of preventative treatment, and professional evaluations of 'relevant' information. The analysis indicates that there exist disparate and distinct approaches to and understandings of CVD pharmaceuticalisation amongst GPs. Depending on how knowledge, treatment perspectives and values variously combine, GPs sit somewhere on a spectrum of how pharmaceuticalised they are in terms of the approaches to and understandings of the prevention of CVD.
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Affiliation(s)
- Tom Douglass
- Department of Communication and Media, Ulster University, Newtownabbey, United Kingdom
| | - Michael Calnan
- School of Social Policy, Sociology and Social Policy, University of Kent, Canterbury, United Kingdom
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Information or Habit: What Health Policy Makers Should Know about the Drivers of Self-Medication among Romanians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020689. [PMID: 33466957 PMCID: PMC7830883 DOI: 10.3390/ijerph18020689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023]
Abstract
We use the Knowledge, Perceptions and Practices framework to analyze determinants of three types of self-medication practices in Romania: (1) self-medication in the case of cold/flu/viral infections; (2) taking non-prescribed medicine in general; and (3) self-medication based on recommendations by others. We analyzed 706 responses to an online survey and used a factor-based Partial Least Squares algorithm (PLSF) to estimate the relationships between each type of self-medication and possible predictors. Our results show that self–medication is strongly predicted by non-cognitive behavioral factors such as habits and similarity of symptoms, while cognitive determinants such as knowledge and understanding of potential risks are not significantly associated with self-medication behaviors. This paper identifies nonlinear relationships among self-medication practices and its predictors and discusses how our results can help policymakers calibrate interventions with better accuracy.
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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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Horter S, Stringer B, Gray N, Parpieva N, Safaev K, Tigay Z, Singh J, Achar J. Person-centred care in practice: perspectives from a short course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan. BMC Infect Dis 2020; 20:675. [PMID: 32938422 PMCID: PMC7493896 DOI: 10.1186/s12879-020-05407-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9–11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health. Methods A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June–July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12. Results People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect. Conclusions There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
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Affiliation(s)
- Shona Horter
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK.
| | - Beverley Stringer
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
| | - Nell Gray
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
| | - Nargiza Parpieva
- RSSPMCPh&P, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Khasan Safaev
- RSSPMCPh&P, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Zinaida Tigay
- Republican Phtiziology Hospital #2, Ministry of Health of Karakalpakstan, Nukus, Uzbekistan
| | | | - Jay Achar
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
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Byrne P, O'Donovan Ó, Smith SM, Cullinan J. A qualitative exploration of the prescribing and use of statins in asymptomatic people in Ireland: A case of medicalisation, biomedicalisation and pharmaceuticalisation. Health (London) 2020; 25:630-648. [PMID: 32715773 DOI: 10.1177/1363459320946067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been a notable increase in the use of statins in people without cardiovascular disease but who may be at risk in the future. The majority of statin users now fall into this category but little research has focused exclusively on this group. Debate has ensued regarding medicating asymptomatic people, and processes described variously as medicalisation, biomedicalisation and pharmaceuticalisation are used to explain how this happens. These overlapping and interrelated processes require issues to be 'problemised' as medical problems requiring medical solutions given the prevailing understandings of health, risk and disease. However, current understandings of risk and disease are not simply the result of technological and scientific advances, they are also socially constructed. We interviewed members of the public, GPs and others, and found that rather than high cholesterol being seen as one of several risk factors that contributes to heart disease, it tended to be promoted simplistically to the status of a disease needing treatment of itself. Statins were justified by those taking them as different to 'unnecessary medicines'. However, some participants demonstrated resistance to statins, worried about over-medicalisation and deviated from accepted practices, indicating a complex 'muddling through' in the face of uncertainty.
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Affiliation(s)
- Paula Byrne
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Ireland
| | - Órla O'Donovan
- School of Applied Social Studies, University College Cork, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Ireland
| | - John Cullinan
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Ireland
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12
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Alageel S, Gulliford MC, Wright A, Khoshaba B, Burgess C. Engagement with advice to reduce cardiovascular risk following a health check programme: A qualitative study. Health Expect 2020; 23:193-201. [PMID: 31646710 PMCID: PMC6978858 DOI: 10.1111/hex.12991] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The success of a cardiovascular health check programme depends not only on the identification of individuals at high risk of cardiovascular disease (CVD) but also on reducing CVD risk. We examined factors that might influence engagement and adherence to lifestyle change interventions and medication amongst people recently assessed at medium or high risk of CVD (>10% in the next 10 years). METHOD Qualitative study using individual semi-structured interviews. Data were analysed using the Framework method. RESULTS Twenty-two participants (12 men, 10 women) were included in the study. Four broad themes are described: (a) the meaning of 'risk', (b) experiences with medication, (c) attempts at lifestyle change, and (d) perceived enablers to longer-term change. The experience of having a health check was mostly positive and reassuring. Although participants may not have understood precisely what their CVD risk meant, many reported efforts to make lifestyle changes and take medications to reduce their risk. Individual's experience with medications was influenced by family, friends and the media. Lifestyle change services and family and friends support facilitated longer-term behaviour change. CONCLUSIONS People generally appear to respond positively to having a CVD health check and report being motivated towards behaviour change. Some individuals at higher risk may need clearer information about the health check and the implications of being at risk of CVD. Concerns over medication use may need to be addressed in order to improve adherence. Strategies are required to facilitate engagement and promote longer-term maintenance with lifestyle changes amongst high-risk individuals.
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Affiliation(s)
- Samah Alageel
- School of Population Health SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
- Community Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Martin C. Gulliford
- School of Population Health SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Alison Wright
- School of Population Health SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Bernadette Khoshaba
- School of Population Health SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Caroline Burgess
- School of Population Health SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
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Polak L, Green J. Rethinking decision-making in the context of preventive medication: How taking statins becomes "the right thing to do". Soc Sci Med 2020; 247:112797. [PMID: 32059130 DOI: 10.1016/j.socscimed.2020.112797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 01/09/2023]
Abstract
To understand decision-making in the context of longterm preventive medication, we explore the way "deciding" articulates with household medication practices and other everyday routines. Taking statins as a case study, we use qualitative data from interviews with 34 participants in the UK who had all been offered statins; 19 were currently taking them. Although all participants reference similar information about statins, the way they assemble and use their knowledge varies: there is a marked asymmetry between participants taking statins and those not taking them. Deliberation is a prominent feature of accounts of deciding not to take statins, but seldom visible within accounts of those taking them. Statin-takers emphasise that they have "no choice" about taking them, while non-takers stress the need to "think about it"; statin-takers' accounts prioritise biomedical tests over experiential knowledge, whereas non-takers sometimes prioritise experiential knowledge. All participants reference similar theoretical and experiential knowledge about side-effects, but whereas non-takers often use this knowledge to explain their decision to decline statins, those taking statins downplay both their own experiences and the likelihood that these are due to statins. To account for these asymmetries, we propose a model of decision-making in which deciding upon a course of action entails constructing a narrative presentation of medication use that frames it as "the right thing to do". This model helps us examine the two-way interactions between decision-making and the material practices through which regular medication gets taken, interactions often elided from accounts both of decision-making and of medication practice. In the context of longterm medication, the boundaries between "deciding" and "doing" are blurred; decision-making is situated within a web of collaborative, discursively-informed practices.
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Affiliation(s)
- Louisa Polak
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - Judith Green
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
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