Challenging social cognition models of adherence: Cycles of discourse, historical bodies, and interactional order

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Attempts to model individual beliefs as a means of predicting how people follow clinical advice have dominated adherence research, but with limited success. In this article, we challenge assumptions underlying this individualistic philosophy and propose an alternative formulation of context and its relationship with individual actions related to illness. Borrowing from Scollon and Scollon’s three elements of social action – “historical body,” “interaction order,” and “discourses in place” – we construct an alternative set of research methods and demonstrate their application with an example of a person talking about asthma management. We argue that talk- or illness-related behavior, both viewed as forms of social action, manifest themselves as an intersection of cycles of discourse, shifting as individuals move through these cycles across time and space. We finish by discussing how these dynamics of social action can be studied and how clinicians might use this understanding when negotiating treatment with patients.
Original languageEnglish
Pages (from-to)283-294
Number of pages12
JournalQualitative Health Research
Issue number2
Early online date17 Sep 2014
Publication statusPublished - Feb 2015


  • adherence /compliance
  • communication
  • discourse analysis
  • ethnography
  • health behavior
  • interviews

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