A Thesis Submitted for the Degree of PhD at the University of Warwick Permanent WRAP URL: http://wrap.warwick.ac.uk/93942 Copyright and reuse: This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. For more information, please contact the WRAP Team at: [email protected] warwick.ac.uk/lib-publications Towards a Process View of Adherence by Peter Michael Ward A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Service Systems University of Warwick, WMG May 2017 Table of Contents Table of Contents ................................................................................................. i List of Figures ..................................................................................................... v List of Tables..................................................................................................... vii Acknowledgements .......................................................................................... viii Declaration ......................................................................................................... ix Abstract ............................................................................................................... x List of Abbreviations ........................................................................................... xi 1 Introduction to this Thesis ................................................................................ 1 1.1 Introduction ................................................................................................ 1 1.2 Current approaches to adherence ............................................................. 1 1.3 Contributions to knowledge ....................................................................... 2 1.4 Scope of this thesis ................................................................................... 4 1.5 Structure of this thesis ............................................................................... 4 1.6 Summary ................................................................................................... 5 Section A: Making the Case for Moving Towards a Process View of Adherence .......................................................................................................... 7 2 Literature Review: Introduction ........................................................................ 9 2.1 Section introduction ................................................................................... 9 2.2 Chapter introduction .................................................................................. 9 2.3 Meanings of consumption ........................................................................ 10 2.4 Definitions of adherence .......................................................................... 11 2.5 Relationship between consumption and behaviour ................................. 15 2.6 Summary ................................................................................................. 16 3 Adherence Outside of Medicine Consumption ............................................... 17 3.1 Introduction .............................................................................................. 17 3.2 Literature review ...................................................................................... 17 3.3 Contributions to a process view of adherence ......................................... 19 3.4 Summary ................................................................................................. 19 4 Adherence in Medicine Consumption ............................................................ 21 4.1 Introduction .............................................................................................. 21 4.2 Overview ................................................................................................. 21 4.3 Relevant reports ...................................................................................... 22 4.4 Literature review ...................................................................................... 25 4.5 Limitations of current research ................................................................ 30 4.6 Relevant behavioural and health-specific models ................................... 32 4.7 Analysis of medicine adherence research ............................................... 38 4.8 Contributions to a process view of adherence ......................................... 39 4.9 Summary ................................................................................................. 39 i 5 Analysis and Consolidation ............................................................................ 41 5.1 Introduction.............................................................................................. 41 5.2 Analysis ................................................................................................... 41 5.3 Consolidation of factors ........................................................................... 42 5.4 Categories, factors and rules................................................................... 43 5.5 Unit of analysis ........................................................................................ 48 5.6 Summary ................................................................................................. 49 6 The Act of Consumption ................................................................................ 51 6.1 Introduction.............................................................................................. 51 6.2 Service-Dominant Logic .......................................................................... 51 6.3 Changes to adherence over time ............................................................ 65 6.4 Summary ................................................................................................. 67 7 Literature Review: Summary and Conclusions .............................................. 69 7.1 Introduction.............................................................................................. 69 7.2 Literature review summary ...................................................................... 69 7.3 Qualitative research justification .............................................................. 71 7.4 Development of Qualitative Propositions ................................................. 72 7.5 Summary ................................................................................................. 74 Section B: Moving Towards a Process View of Adherence .............................. 77 8 Research: Introduction ................................................................................... 79 8.1 Section introduction ................................................................................. 79 8.2 Chapter introduction ................................................................................ 80 8.3 Summary ................................................................................................. 80 9 Research Philosophy, Ontology, Epistemology and Methodology ................. 81 9.1 Introduction.............................................................................................. 81 9.2 Why Critical Realism? ............................................................................. 81 9.3 Philosophy ............................................................................................... 82 9.4 Ontology .................................................................................................. 83 9.5 Epistemology ........................................................................................... 85 9.6 Methodology ............................................................................................ 85 9.7 Summary ................................................................................................. 89 10 Qualitative Research Method ....................................................................... 91 10.1 Introduction............................................................................................ 91 10.2 General approach .................................................................................. 91 10.3 Qualitative Proposition 1 ....................................................................... 93 10.4 Qualitative Proposition 2 ....................................................................... 94 10.5 Development of research questions ...................................................... 98 10.6 Summary ............................................................................................... 99 11 Qualitative Research Results and Analysis ............................................... 101 11.1 Introduction.......................................................................................... 101 11.2 Initial discussion .................................................................................. 101 ii 11.3 Qualitative Proposition 1 ...................................................................... 103 11.4 Qualitative Proposition 2 ...................................................................... 110 11.5 Summary ............................................................................................. 118