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

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 2017-04, Vol.111 (4), p.154-162
• Main Authors: Engelman, Daniel, Ah Kee, Maureen, Mataika, Reapi L., Kado, Joseph H., Colquhoun, Samantha M., Tulloch, Jim, Steer, Andrew C.
• Format: Article
• Language: English
• Subjects: 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; Medication Adherence - statistics & numerical data; Penicillin G Benzathine - therapeutic use; Reminder Systems - utilization; Rheumatic Heart Disease - drug therapy; Rheumatic Heart Disease - psychology; Risk Factors; Secondary Prevention - methods
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/trx035

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.