Abstract
GAGNON M, JACOB JD and GUTA A. Nursing Inquiry 2013; 20: 60–70 Treatment adherence redefined: a critical analysis of technotherapeuticsTreatment adherence issues in the context of chronic illnesses have become an important concern worldwide and a top priority in the field of health-care. The development of devices that will allow healthcare providers to track treatment adherence and monitor physiological parameters with exact precision raises important questions and concerns. The aim of this study is to interrogate the use of these new technological devices which allow for previously unavailable data to be recorded on an ongoing basis and transmitted via a tiny microchip inserted into the body. Drawing on the work of Michel Foucault, we analyze how this anatomo-political and bio-political instrument serves to discipline chronically ill individuals and govern the health of entire populations who suffer from chronic conditions. To support our analysis, this article comprises three sections. First, we provide an overview of treatment adherence and technotherapeutics. Then, we explain how technotherapeutics concern the government of bodies and conducts at the individual level and population level more generally. Lastly, we provide an example of how this analysis can be connected to routine nursing practice in the field of HIV.
Highlights
Treatment adherence issues in the context of chronic illnesses have become a major concern worldwide and a top priority in the field of health-care
That technotherapeutics will be deployed to discipline chronically ill individuals by means of continuous surveillance and govern the health of entire populations who are seen as noncompliant, potentially dangerous, and overly costly
The primary and desired effects sought by this normalizing process are to encourage self-discipline and nourish the desire of each individual to conform to expectations. This process is fundamental to the functioning of disciplinary power; pre-determined adherence rates that serve to constitute the norm encourage desired conducts, habits, and attitudes but allow for an intervention to take place in times of deviance. Technotherapeutics make it possible to intervene promptly in this particular situation and leave very little maneuverability for chronically ill individuals who must cope with the many challenges they face on a daily basis
Summary
Treatment adherence issues in the context of chronic illnesses have become a major concern worldwide and a top priority in the field of health-care. This process is fundamental to the functioning of disciplinary power; pre-determined adherence rates that serve to constitute the norm encourage desired conducts, habits, and attitudes but allow for an intervention to take place in times of deviance (non-adherence) Technotherapeutics make it possible to intervene promptly in this particular situation and leave very little maneuverability for chronically ill individuals who must cope with the many challenges they face on a daily basis. We understand technotherapeutics as serving to both discipline individual bodies and to regulate whole groups of people deemed to constitute a threat to the collective body In this sense, we consider that adherence work is above all a political project that endeavors to achieve optimal disease management (through surveillance and discipline), reduce the financial burden of treatment non-adherence on healthcare systems, and serve to further marginalize and differentiate ‘at-risk groups’ because of their unwillingness or inability to conform
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