Training-and-Communication Package
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SECONDARY
We assumed that support for the behaviors of patients and healthcare workers would be needed to understand and maximize the benefits of new diagnostics and algorithms. As such, we conducted a pre-intervention, qualitative research study to investigate the social, economic, and cultural factors that support or hinder patients’ adherence to prescriptions and the communication of adherence messages from healthcare workers, with additional qualitative components nested into the clinical trial. A T&C intervention package was then developed based on this research, which consisted of a set of communication messages presented to patients in local languages at the point of prescribing, and associated training for healthcare workers to deliver the messages. The outcomes of this qualitative work are also reported in this supplement issue (Compaoré et al).Study nurses in the intervention arm were trained on the use of the algorithm and the intervention package designed by the social science team and on the design of message addressed to each participant, parent, or guardian, based on their knowledge of antibiotics and their understanding of the prescription made. At the day 7 visit, nurses collected information on antibiotic procurement in both arms and performed a pill count of remaining medications.For the secondary objective of adherence to the prescription, adherence was defined as buying or obtaining the prescribed medicines and taking those medicines in line with the duration, frequency, and dosage stated in the prescription. For patients whose prescription did not include an antibiotic, this meant that, to adhere, they must have not subsequently bought/obtained an antibiotic. As part of the qualitative component of work, social scientists conducted in-depth interviews (IDIs) with study patients, through which they learned if the patient had adhered to the prescription. This information was added to the patient’s clinical record form for quantitative analysis of secondary objectives, and further qualitative analysis was conducted on a sample of interview recordings. In this paper, we limit reporting to the quantitative analysis.Prescription adherence is calculated from the data collected primarily through the patient’s IDI or direct report to nurse; where that is not available, the pill count (>90%) is used and is calculated for patients who were prescribed an antibiotic, and not prescribed an antibiotic as described above. The results of this primary analysis and subcomponent analysis are provided in the discussion (adherence).