Abstract
Introduction: Medication non-adherence in chronic illness remains a critical bottleneck to optimal healthcare delivery, directly associated with elevated morbidity, mortality, and systemic expenditures. This narrative review was aimed to explore the emic perspectives of patients undergoing lifelong treatments, examining how they generate unique experiential knowledge to navigate the daily realities of chronic disease.
Methods: This study employed a conceptual/narrative review design informed by an interpretivist epistemology. A systematic search of PubMed, Scopus, and Google Scholar was conducted for literature published from database inception to date of review. Given the conceptual nature of the review, the author prioritized theoretical, philosophical, and empirical qualitative studies that explicitly addressed patient subjective experience in lifelong treatment. Data synthesis followed a reflexive thematic approach, iteratively identifying core constructs across the selected literature. Utilizing an interpretivist approach, this review synthesizes Maurice Merleau-Ponty’s phenomenology of the “phenomenal body” alongside contemporary frameworks of subjective medication experiences, Leventhal’s Common-Sense Model, and Social Comparison Theory.
Results: Lifelong treatment alters the phenomenal body and disrupts the pre-reflective, silent experience of daily life. To cope with disease chronicity, the unbounded duration of treatment, and psychosocial changes, patients actively construct an alternative framework of meaning, termed “lay pharmacology”. This patient-constructed knowledge dictates intentional non-adherence as a rational mechanism to regain personal autonomy and control.
Conclusion: Resolving non-adherence requires a paradigm shift from expert-driven compliance metrics toward frameworks that validate patient-constructed knowledge. Integrating Shared Medical Decision-Making, Narrative Medicine, and Critical Health Literacy into clinical practice is essential to align clinical guidelines with the patient’s lived reality.