‘Everybody has to think – do I have any peanuts and nuts in my lunch?’ School nurses, collective adherence, and children's food allergies

Abstract

Developing robust explanations for patients’ non-adherence to medical treatments is a pressing clinical concern. Social scientists have emphasised the importance of taking a ‘patient-centred’ approach to the study of illness management. Using data from a qualitative study of the management of children's food allergies, I found that school nurses created what I term collective adherence – the translation of individual medical recommendations into prescriptions to be followed by entire communities. School nurses secured collective adherence by aligning physicians, schools, and families around a particular interpretation of medical recommendations, setting guidelines of behaviour for the entire school community to follow, and balancing the diverging needs of illness sufferers and non-illness sufferers. This study contributes to the study of adherence by examining the medical recommendation as a dynamic prescription, extending adherence to the study of ancillary providers’ interaction with medical recommendations, and examining the impact of illness on non-family ties. I conclude with a discussion of implications for the field of school nursing; and potential applications of the collective adherence framework to the management of health conditions and health risks.