Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

Abstract

Objectives:To determine the level of adherence and possible barriers to secondary prophylaxis among clients with rheumatic fever in Kingston, Jamaica. Methods: Cross-sectional survey of 39 clients diagnosed with rheumatic fever, receiving penicillin prophylaxis for more than a year using a 22-item self-administered questionnaire on adherence to secondary prophylaxis and knowledge of rheumatic fever. The patients' records were reviewed to determine the number of prophylaxis injections the patients received for the year 2010. Results: The majority of participants (74%) were females and 51% were adults. Only 48.7% had a high level of adherence. The majority (72%) had low knowledge levels regarding their illness, while only 5% had a high knowledge level score. Most clients (70%) strongly agreed that nurses and doctors encouraged them to take their prophylaxis. However, over 60% reported that they travelled long distances and or waited long periods to get their injections. One-third reported that they missed appointments because of fear of injections and having to take time off from work or school. Discussion: Clients attending the health centers studied had limited knowledge about rheumatic fever. Barriers to adherence included fear of the injections, long commutes, and long waiting periods at the facilities studied.

<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

“…23 Furthermore, different studies reported reasons for poor adherence were lack of money, far distance from hospital, fear of medication side effects and painful injection, lack of awareness of the importance of BPG, and non-availability of BPG. 15,24,25 On the contrary, the adherence rate of the present study (80.6%) was less than that of Indian and New Zealand studies which reported (89.6%) 26 and (92%) 27 respectively. Another prospective study conducted in India also showed the overall adherence rate of 93.6%.…”

“…14 Several factors including psychosocial-, demographic-, and medical-related characteristics have been identified as attributes to nonadherence with BPG secondary prophylaxis. 15,16 In Ethiopia, RHD is one of the major health problems resulting in significant morbidity and mortality. [16][17][18][19] From our healthcare experiences, there were concerns on adherence to monthly BPG prophylaxis.…”

Enablers and barriers to secondary prophylaxis for rheumatic fever among Māori aged 14–21 in New Zealand: a framework method study

“…These data are consistent with literature about children and adolescent adherence to treatment for chronic illnesses including the challenge of reaching adolescents who are seeking and asserting independence and their own identity [ 22 , 23 ]. Prior research has identified a number of factors contributing to adherence of secondary prophylaxis for ARF in developing countries and underserved populations in developed nations (e.g., Aboriginal and Torres Strait Islanders in Australia) [ 15 , 20 , 21 , 24 – 29 ]. Although they have not been organised previously in this manner, there are four key factors: health system, access/resources, relational and individual.…”

“…Access/resources refer to the (lack of) assets that inhibit or facilitate adherence. A major barrier in many studies is the lack of access to treatment for patients exacerbated by living rurally or remotely [ 21 , 24 , 29 , 31 ]. Another resource is time off work to get the injections [ 24 ].…”

Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji

“…The most frequent benchmark used to categorise adherent vs . non‐adherent or poorly adherent has been 80% of recommended injections , although others have used 90% . Although there is no particular pathophysiological basis for any threshold, there is some empirical evidence for the 80% cut‐off from other chronic diseases .…”