Such change disrupts the process of brand loyalty, built up over time, to the drug. Moreover, this substitution rarely involves just one generic drug that remains constant, but different generic brands based on the pharmacy's supply, creating a lack of reference points name, colour and shape of tablets for patients.
It compromises the product identification process for building a strong connection between the drug and the individual who takes it. Loyalty to a drug has also been found in ordinary practices among people who have integrated drug intake into their daily activities, favouring the perpetuation of drug use already described for long-term treatments Fainzang ; Sow and Desclaux ; Pierret This translates into an intake routinization, often organized around meals.
Antihypertensive drugs were usually stored, or at least taken, in the kitchen 10 to ensure their visibility; they were kept in salvaged everyday objects converted from their original function. According to Fainzang , places where medicines are kept correspond to various modes of perception of these drug-things and the importance attached to them.
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Along with ingesting them at mealtime, it underlines the close relationship between food and drugs, also attesting to the patients' acceptance of treatment and confidence in a therapy that is necessary for their survival, similar to the need to eat food several times a day. How drugs are stored and ingested and the multiple tricks used to avoid forgetting them convey the individuals' pragmatism.
Moreover, it also reveals their creativity in the use and ultimate appropriation phase of a good such as drugs that has been imposed on them. One of these tactics was skipping hypertension treatment during the weekends. I don't know why but often voluntarily on Sunday, I don't take them. It's not forgetting. It's a day of complete rest!
Is it to rest my stomach? I have no idea.
Therefore, we can hypothesize that the therapeutic break perpetuates the use of the drug — and possibly strengthens long-term adherence — because it is a transitory break in the daily repetition of activities, making it possible to tolerate the monotony of the routine.
They did not define adherence in terms of a threshold or doses of ingested drugs. The term adherence never appeared anywhere in their comments. These locutions alternately designated watching their diet, avoiding alcohol and tobacco, regularly taking their drugs, maintaining regular follow-up consultations and following medical advice.
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Consequently, doctors' suspicion about inadequate drug compliance for uncontrolled hypertension was poorly accepted by patients because it attests to the doctor's lack of confidence in them. Indeed, the hypertensive patient's narratives revealed that following a prescription referred to an asymmetric doctor—patient relationship marked by submission to medical decision-making and obedience to the doctor, the holder of knowledge. Nevertheless, obedience does not exclude negotiation, and several hypertensive patients described situations in which they negotiated decisions about seeking a specialist or the prescribed drug by sometimes imposing their viewpoint on the doctor.
The patients also expressed dissatisfaction concerning the lack of information provided by doctors on the drugs' mode of action or their adverse effects. They ascribed this insufficient information to the doctor's unavailability. However, by excusing the doctors, they disregarded other factors such as the social distance, directivity or paternalism associated with practitioners in the doctor—patient interaction that are often objectified by the social sciences Fainzang The sociology of trust Giddens ; Watier has shown the fundamental role that trust plays in structuring social relationships.
Although there exist negative feelings among patients and practitioners, as well as areas of mistrust, the trust relationship is a cultural schema that codifies each partner's behaviour in the doctor—patient relationship and allows them to interpret conduct. Collected narratives from the patients explicitly or implicitly described an idealized relationship that most recognize or aspire to recognize, in which trust simultaneously results from an interpersonal relationship and the sine qua non condition of confidence in and adherence to treatment.
Based on narratives from hypertensive patients, the idea of trust was a complex and polysemous notion. Our analyses found several forms of trust. Reasoned trust concerns the practitioner's professional competence, mentioned by patients who were attentive to their doctor's knowledge, professional experience and scientific rigour. However, it goes beyond this, and the analysis showed another dimension that we have termed emotional trust. This doctor was so close to patients that he or she was sometimes perceived as a family member or friend.
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Therefore, the relationship with the doctor was a personalized and long-lasting relationship that resulted in gaining greater, enduring mutual trust. In the doctor—patient interaction — whether it corresponds to the paternal-istic model or the shared decision-making model — drugs participate in symbolic exchanges.
Nevertheless, adherence can be considered a form of symbolic gratification objectifying the trust granted to the doctor as well as submission to medical authority based on medical expertise. We have termed this third dimension of trust conceded trust. Here, a high level of adherence was also conceded by the patient based on medical expertise and the doctor's professional responsibility, as highlighted by Collin In effect, some hypertensive patients have underscored that they had no other choice than to trust the practitioner.
Following long-term treatment is a complex process that combines the patient's acceptance of a drug with its integration into daily life, identification and personalization of the drug as well as loyalty to it; additionally, it integrates loyalty to the doctor. It objectifies the patient's level of trust towards the doctor and recognition of his or her role as expert and as family physician. However, it also involves factors that are external to the patient, the drug and the therapeutic relationship as well as involving the drug's symbolic dimensions.
The hypertensive patient self-regulates his or her medication from day to day. This regulation corresponds to logics of experimentation, controlling health risks, controlling the body and treatment, controlling side effects, controlling ingestion, limiting constraints imposed by the prescription renewing the prescription , ensuring treatment continuity drug packaging , managing social integration, developing drug-taking habits and routinization.
The authors would like to thank Sharon Calandra, who translated the original French version of this paper into English. However, similar studies in other chronic pathologies show the same categories of factors, with the addition of institutional factors constraints on patient linked to follow-up, such as consultation schedules, the patient's travel distance to the institution, travel costs, etc.
As for me, I don't have any boxes of 28; that's for women! Ordonnance means the promulgation of decisions that are related to a law. Their narratives are quite homogeneous. In this second group, we actually collected more negative narratives towards doctors, but these implicitly show an ideal relationship based on trust. National Center for Biotechnology Information , U. Journal List Healthc Policy v.
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Healthc Policy. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Objective: Uncontrolled high blood pressure leads clinicians to wonder about adherence degree among hypertensive patients. Methods: The medical inductive and comprehensive anthropological approach implemented is based on an ethnographic survey observations of consultations and interviews.
Results: Antihypertensive drugs are reinterpreted when filtered through the cultural model of physiopathology the body as an engine. Conclusion: Consideration and understanding of these pragmatic and symbolic issues by the treating physician should aid practitioners in carrying out their role as medical educators in the management of hypertension.
Factors determining the level of antihypertensive drug adherence have been identified as follows 2 : Factors linked to treatment: The complexity of the treatment the number of daily doses and the drugs' side effects sexual dysfunction, polyuria in specific social situations are considered barriers to adherence Reugel et al. Methods Our anthropological approach is based on an ethnographic survey conducted from October to April in a rural area of southeastern France. Results and Discussion The ethnology of the experience of hypertension and antihypertensive treatments enabled us to construct a semantic network for high blood pressure, to analyze the underlying logics that influence treatment acceptance and following prescriptions and to analyze the perceptions that individuals may have about cardiovascular risk and how to reduce this risk.
Confidence 4 in treatment Confidence in treatment corresponds to the consistency between the patient's and doctor's perceptions of its value Sow and Desclaux Social Representations of the Body and Physiology Analogous and metaphorical logics contribute to ascribing the event the illness to instrumental causes within cultural etiological models. Self-regulation of treatment Experimenting with Treatment and Controlling Side Effects As described in other chronic diseases Conrad ; Collin , ; Haxaire ; Pierret , the occasional or prolonged failure to take drugs, whether accidental or voluntary, allowed high blood pressure patients to experiment with the effects on the body of treatment interruption and thus to gain knowledge about the disease.
Ensuring Treatment Continuity Analysis of the ethnographic data also revealed personal strategies for adjusting treatment to avoid accidents in adherence or running out of drugs packaged in boxes of 28 tablets. Integrating Treatment Into Daily Life Loyalty to a drug has also been found in ordinary practices among people who have integrated drug intake into their daily activities, favouring the perpetuation of drug use already described for long-term treatments Fainzang ; Sow and Desclaux ; Pierret Conclusion Following long-term treatment is a complex process that combines the patient's acceptance of a drug with its integration into daily life, identification and personalization of the drug as well as loyalty to it; additionally, it integrates loyalty to the doctor.
Acknowledgements The authors would like to thank Sharon Calandra, who translated the original French version of this paper into English. Bulletin du cancer. Journal of Clinical Hypertension. Social Science and Medicine. Trois cas de figure. Arts de faire. Paris: Folio Essais; L'invention du quotidien, 1. Revue du praticien. In: Nicassion P. Managing Chronic Disease. Une fabuleuse machine: anthropologie des savoirs ordinaires sur les fonctions physiologiques. Health Technology Assessment. Paris: PUF; Methods for Measuring and Monitoring Medication.
Clinical Therapeutics. The Consequences of Modernity. Medicine, Rationality and Experience. Improvement of Medication Compliance in Uncontrolled Hypertension. Une belle plante. Scandinavian Journal of Primary Health Care. Patient Education Counselling.
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Culture, Medicine and Psychiatry. Archives des maladies du coeur et des vaisseaux. Passions du risque. Pratiques et savoirs populaires. Journal of Hypertension. Journal of Clinical Pharmacology. In: Bessette D. Concepts and Issues in Adherence. In: Myers L. Adherence to Treatment in Medical Conditions. Buffalo, NY: Hardwood; Risques de transmission du SIDA et perceptions de la contagion. Le Sens du mal. Essai sur le risque cardio vasculaire. Le Retour du Dr Knock. Le traitement de L'HTA et les dysfonctions sexuelles, une cause certaine de mauvaise observance du traitement?
Le Sens de l'observance. In: Rossi I. De la divination au pronostic. Population report Various fields of research increasingly use the European Union Statistics on Income and Living Conditions EU-SILC database because of its large country coverage, the availability of harmonized socioeconomic measures, and the possibility of merging partners. Its measures of the number of children risk being biased, however, because the questionnaire does not directly ask about the number of children ever born to a woman or man, and only those children who live in the parental household are observed.
These limitations are problematic not only for demographic but also for socioeconomic analysis because family size and fertility behaviour are important determinants of income and living conditions. For ten countries, we first quantify the bias in the reported number of children, distinguishing fertility measures by age and birth order.
We then identify the socioeconomic profiles that are most subject to biased measures.