Adam B D, Maticka-Tyndale E, Cohen J J
Department of Sociology and Anthropology, University of Windsor, Ontario, Canada N9B 3P4.
AIDS Care. 2003 Apr;15(2):263-74. doi: 10.1080/0954012031000068407.
This paper offers a critique of patient-deficit models of adherence by examining the articulation of dosing schedules and food prohibitions with the structure of everyday lives. Interviews with 31 men and 4 women taking HAART show that doses associated with regular daily life events are most consistently taken, but many individuals rework official dosing guidelines around timing and food consumption. Barriers to adherence often arise from conflicting demands imposed by work schedules, different medications, food prohibitions, and even outright discrimination as in the case of US immigration policy. Adherence may be the outcome of compromises made in an effort to solve contradictory demands, and may be situational and related to the qualities of particular drugs, as much as to personality traits. Autobiographical narratives that give order to one's sense of self provide foundations upon which adherence decision making occurs. Finally, perceptions of drug effectiveness may lead to self-reinforcing adherence practices.
本文通过审视服药时间表和饮食禁忌与日常生活结构的关联，对依从性的患者缺陷模型提出了批评。对31名男性和4名服用高效抗逆转录病毒疗法（HAART）的女性进行的访谈表明，与日常常规生活事件相关的剂量最能始终如一地按时服用，但许多人会根据时间安排和食物摄入情况对官方服药指南进行调整。依从性的障碍往往源于工作时间表、不同药物、食物禁忌甚至像美国移民政策那样的直接歧视所带来的相互冲突的要求。依从性可能是为解决相互矛盾的要求而做出妥协的结果，可能是情境性的，与特定药物的特性以及个人性格特质都有关系。赋予个人自我认知以秩序的自传性叙述为依从性决策提供了基础。最后，对药物疗效的认知可能会导致自我强化的依从性行为。
