Secondary prevention for screening detected rheumatic heart disease: opportunities to improve adherence.

Abstract

Background:

Secondary prevention is an effective treatment for rheumatic heart disease (RHD), but ensuring high adherence to prophylaxis over many years is challenging and requires understanding of local factors.

Methods:

Participants were young people diagnosed with RHD through echocardiographic screening in Fiji. We used a structured interview to evaluate the following: health seeking behaviours; attitudes, practice, barriers and potential improvement strategies for adherence to antibiotic prophylaxis; and adolescent-friendly qualities of the health service.

Results:

One hundred and one participants were interviewed (median age, 17.2 years). Adherence was very low overall (adequate in 6%). Sore throat and fever with sore joints were experienced in the preceding year by 42% and 28%, respectively. Barriers to receiving treatment included taking alternate treatments and the perception that symptoms were benign and self-limiting. Reasons for missing prophylaxis injections included lack of awareness, feeling well, transport cost and access, and medication unavailability (>40% of participants each). The injection health service had many perceived strengths, but inclusion of adolescents in decision making, and quality of educational materials were deficiencies. Reminder strategies, particularly phone-based reminders, were considered helpful by 94%.

Conclusions:

We identified several factors influencing secondary prevention that may be used to develop interventions to improve adherence.

• Authors: Daniel Engelman, Maureen Ah Kee, Reapi L Mataika, Joseph H Kado, Samantha M Colquhoun, Jim Tulloch, Andrew C Steer
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene (Trans R Soc Trop Med Hyg) Vol. 111 Issue 4 Pg. 154-162 (04 01 2017) ISSN: 1878-3503 [Electronic] England
• PMID: 28673022 (Publication Type: Journal Article)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Penicillin G Benzathine

Topics

• Adolescent
• Adolescent Behavior
• Adolescent Health Services
• Antibiotic Prophylaxis
• Directive Counseling (methods)
• Female
• Fiji (epidemiology)
• Health Knowledge, Attitudes, Practice
• Humans
• Interviews as Topic
• Male
• Medication Adherence (psychology, statistics & numerical data)
• Penicillin G Benzathine (therapeutic use)
• Reminder Systems (statistics & numerical data)
• Rheumatic Heart Disease (drug therapy, psychology)
• Risk Factors
• Secondary Prevention (methods)