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Evaluating the use of job aids and user instructions to improve adherence for the treatment of childhood pneumonia using amoxicillin dispersible tablets in a low-income setting: a mixed-method study.

Abstract：

OBJECTIVES:We conducted a study to evaluate the use of job aids and simple user instructions to improve adherence for the treatment of childhood pneumonia with amoxicillin dispersible tablet (DT). DESIGN:A mixed-method study implemented in three phases between October 2015 and February 2016. SETTINGS:The study was implemented in two subdistricts of Bangladesh. PARTICIPANTS:Caregivers of children aged 2-59 months, health service providers and key stakeholders at national and district level. INTERVENTIONS:An intervention including training and job aids and user-friendly instructions was introduced in one subdistrict while standard amoxicillin DT packaging and instructions with no training served as the control in the comparison subdistrict. PRIMARY OUTCOME:Adherence behaviour of caregivers of children aged 2-59 months for the treatment of childhood pneumonia with amoxicillin DT. METHODS:We conducted a survey with 56 caregivers in the intervention subdistrict and 38 caregivers in the comparison subdistrict. We also conducted 44 in-depth interviews to evaluate the job aids and user-friendly instructions with healthcare providers and caregivers to assess the feasibility, usability and acceptability of the tools in intervention subdistrict. RESULTS:For 5-day treatment course, 32.1% (95% CI 23.1% to 41.1%) of caregivers in the intervention subdistrict and 2.6% (95% CI 0.3% to 7.8%) in the comparison subdistrict maintained full adherence to the amoxicillin DT treatment for pneumonia. More children under 12 months were given age-appropriate treatment than older children. Key stakeholders and healthcare providers considered the use and integration of the tools into the health system to be feasible and acceptable. CONCLUSIONS:The provision of tools for the treatment of childhood pneumonia with amoxicillin DT had a positive influence on adherence behaviours. These tools can help close information gaps and overcome the barriers posed by medical illiteracy and remembering instructions from providers.

journal_name

BMJ Open

journal_title

BMJ open

authors

Sarma H,Gerth-Guyette E,Shakil SA,Alom KR,Abu-Haydar E,D'Rozario M,Tariqujjaman M,Arifeen SE,Ahmed T

doi

10.1136/bmjopen-2018-024978

subject

Has Abstract

pub_date

2019-05-30 00:00:00

pages

e024978

issue

issn

2044-6055

pii

bmjopen-2018-024978

journal_volume

pub_type

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Evaluating the use of job aids and user instructions to improve adherence for the treatment of childhood pneumonia using amoxicillin dispersible tablets in a low-income setting: a mixed-method study.