Exploring the acceptability of a visual intervention to improve paediatric adherence to antiretroviral therapy in South Africa

Bradshaw, Melissa Elizabeth (2019-04)

Thesis (MA)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: Near-perfect levels of adherence are required by children five years and younger on ART in order to achieve optimal treatment outcomes. Caregivers of children on ART are fundamental in ensuring their child achieves high levels of adherence, as they are responsible for administering medication to the child. Caregivers require the necessary adherence-related information, motivation, and behavioural skills to ensure their child remains adherent to ART. However, these components are often affected by caregiver, child, and medication regimen characteristics, as well as contextual and healthcare related factors. Whilst there are a number of children who are non-adherent to ART, effective interventions targeted at this age group are not available. Visual interventions, such as the Petrie device demonstration developed in accordance with the IMB-model, has shown potential in enhancing medication adherence, and may be appropriate for use with caregivers of children on ART. In this study, I explored the acceptability of the Petrie device demonstration with caregivers of young children on ART. Participants included in the study were eleven caregivers to children five years and younger on ART, attending outpatient clinics within the City of Cape Town Municipality, South Africa. Data describing participants’ understanding and beliefs of their child’s diagnosis and treatment, medication knowledge, and adherence-related factors were collected using questionnaires. Interviews and a brief questionnaire were used to determine how participants reacted to the device after seeing it. The quantitative data was analysed using descriptive analyses Thematic analysis was used to analyse the qualitative data. Participants reported high levels of adherence despite experiencing various barriers to adherence. The Petrie device demonstration was found to be acceptable to participants. The demonstration increased adherence-related knowledge and motivation, which led to some participants suggesting changes in medication administration behaviour that they intended to implement. As the demonstration may prove effective in enhancing adherence to ART, future research should be conducted to determine the efficacy of the device in doing so. Whilst the demonstration appears suitable for use as part of routine clinical practice, aspects of implementation and feasibility require further work.

AFRIKAANSE OPSOMMING: Om optimale behandelingsuitkomste te bereik, word byna perfekte vlakke van nakoming vereis van kinders vyf jaar en jonger op ART. Versorgers van kinders op ART is van noodsaaklike belang om te verseker dat hul kind hoë vlakke van nakoming bereik, aangesien hulle verantwoordelik is vir die toediening van medikasie aan die kind. Versorgers benodig die nodige nakomingsverwanteinligting, -motivering en -gedragsvaardighede om te verseker dat hul kind ART getrou neem. Alhoewel, hierdie komponente word dikwels beïnvloed deur versorger, kind, en medikasie-regime eienskappe, sowel as kontekstuele en gesondheidsorg verwante faktore. Alhoewel daar 'n aantal kinders is wat nie ART getrou neem nie, effektiewe ingrypings wat op hierdie ouderdomsgroep gerig is, is nie beskikbaar nie. Visuele ingrypings, soos die Petrie-apparaat demonstrasie wat ontwikkel is in ooreenstemming met die IMB-model, het potensiaal gewys om medisyne-nakoming te verbeter, en mag toepaslik wees vir gebruik by versorgers van kinders op ART. In hierdie studie het ek die aanvaarbaarheid van die Petrie-apparaat demonstrasie met versorgers van jong kinders op ART ondersoek. Deelnemers wat in die studie ingesluit was, was elf versorgers van kinders vyf jaar en jonger op ART, van buitepasiënte klinieke binne die Stad Kaapstad Munisipaliteit, Suid-Afrika. Data wat die deelnemers se begrip en oortuigings van hul kind se diagnose en behandeling beskryf, asook medikasie kennis en nakomings-verwante faktore, is ingesamel deur middel van vraelyste. Onderhoude en 'n kort vraelys was gebruik om te bepaal hoe deelnemers gereageer het op die toestel nadat hulle dit gesien het. Die kwantitatiewe data is geontleed deur beskrywende analise. Tematiese analise is gebruik om die kwalitatiewe data te ontleed. Deelnemers het hoë vlakke van nakoming gerapporteer ten spyte van verskeie faktore wat die potensiaal gehad het om nakoming negatief te beïnvloed. Die Petrie-apparaat demonstrasie was aanvaarbaar gevind deur deelnemers. Die demonstrasie het nakomingsverwante kennis en motivering vermeerder, wat gelei het tot sommige deelnemers wat veranderinge in medikasieadministrasiegedrag voorgestel het, wat hulle beplan om te implementeer. Aangesien die demonstrasie effektief kan wees om die nakoming aan ART te verbeter, moet toekomstige navorsing gedoen word om die doeltreffendheid van die apparaat te bepaal. Alhoewel die demonstrasie skynbaar geskik is vir gebruik as deel van roetine kliniese praktyk, benodig aspekte van implementering en uitvoerbaarheid verdere ondersoek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106174
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