| There are over 45 million medically uninsured individuals in the United States and 90 million individuals with chronic illnesses. And, as the profession of pharmacy moves towards the provision of pharmaceutical care, a patient-centered practice, it is important to gain an understanding of patients' medication and illness experiences as well as the socioeconomic context that affects a patient's care, like uninsurance. The illness experience literature is extensive in medicine and nursing, however, the exploration of marginalized groups like the uninsured is largely missing. The number of uninsured has been increasing both nationally as well as in the state of Minnesota. The awareness of the uninsured has occurred primarily through national surveys with a limited understanding of the experience for those who live it. This study explores the experience of living with chronic illnesses for uninsured individuals. The methodology is hermeneutic phenomenology with the use of in-depth, unstructured interviews. The participants include eleven adults, twenty-seven to sixty-four years of age, each with at least two chronic illnesses and uninsured for a period from one to twenty-seven years. Additionally, over one hundred individuals responded to the recruitment flier and offer insight into the meanings of illness and uninsurance. The interviews were audio taped, transcribed and subsequently analyzed for themes. The analysis and interpretation of the data uncovered the following: (1) The experience of uninsurance was primarily a fear of the unknown. (2) The chronic illness experience included themes divided into the chronic illness course, lived body in illness and access, care and providers. (3) The essence of the medication experience was expressed as variations on control. This study challenges the assumptions about the uninsured and offers a deeper understanding of the medication experience. Additionally, this study adds to the illness experience literature, specifically offering an understanding of the uninsured individual's illness experience. The findings also reveal ethical implications important for clinical researchers whose subjects are uninsured. Lastly, this research provides health care practitioners with valuable information to provide patient-centered care to medically uninsured individuals. |
