Abstract
adherence behaviors, ’, nonadherence, acute febrile illnesses
A. C., D. E.-S., D. K.-M., V. K., and S. O. contributed equally to the research and are co–lead authors.Study group members are listed in the Notes.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.In this Viewpoint, the authors explore the determinants of patients’ prescription adherence behaviors as part of FIND's Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Research findings from Burkina Faso, Ghana, and Uganda show that basic knowledge and understanding of prescription instructions are essential for adherence and can be improved through better communication. However, there are a range of other factors that influence adherence, some of which can be influenced through tailored communication messages from healthcare workers. These messages may contribute to changes in adherence behavior but may require other reinforcing interventions to be effective. Finally, there are some drivers of nonadherence centered around costs and time pressure that require other forms of intervention.In this Viewpoint, we explore the determinants of patients’ prescription adherence behaviors as part of the Antimicrobial Resistance Diagnostics Use Accelerator clinical trial in Burkina Faso, Ghana, and Uganda.In this Viewpoint, we combine our experiences exploring the determinants of patients’ prescription adherence behaviors as part of the Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Prescription adherence is defined as obtaining (buying or being given) the prescribed medicine and taking that medicine following the prescription instructions of dosage, frequency, and duration. The ADIP trial was primarily designed to evaluate the impact of a package of interventions on antibiotic prescriptions among patients with acute febrile illnesses at primary health centers in low- and middle-income countries (LMICs). The package of interventions included point-of-care tests, diagnostic algorithms, and training and communication (T&C) packages developed based on preintervention qualitative research [This research took place in the clinical trial sites in Burkina Faso, Ghana, and Uganda, and was integrated into the trial intervention and subsequent patient follow-up (for more details, please see the first article in this supplement, by Olliaro et al).Research findings illustrate a wide range of behavioral drivers that impact patients’ adherence to prescriptions. Basic knowledge and understanding of the prescription instructions (drug type, tolerability, frequency and duration of treatment) are essential for adherence and can be addressed through improved communication. Beyond basic knowledge, research highlights a host of compounding factors that influence adherence, which we hypothesize could be shaped by improved knowledge and persuasion delivered through communication from the healthcare worker (HCW). We believe that the messages will contribute to changes in adherence behavior but would require other reinforcing interventions. Finally, there are some critical behavior drivers centered around costs to patients and time pressure on HCWs, which need other forms of intervention.