Stimulating adherence through pictorial medicine instructions

Abstract

Non-adherence to antibiotic is a major public health problem. Previous studies found that understanding and adherence to antibiotic instructions increased when the oral instructions from the pharmacists were supported by pictorial medicine instructions. However, due to their design it remains unclear for what reason adherence and understanding increased. Therefore, this study aimed to explore (1) how caregivers give an antibiotic treatment, (2) for what reason caregivers give treatment this way, and (3) if including pictorial medicine instructions have an influence on this and if so in what way. Pictorial medicine instructions for Amoxicillin syrup were developed and pretested in Kilifi and Kisumu, Kenya. These pictorial instructions were given together with the Amoxicillin syrup to caregivers whose child was diagnosed with pneumonia at the pharmacies of two different public clinics in Kisumu. A qualitative study using semistructured in-depth interviews with 27 respondents, structured observations and focus group discussions were conducted over a period of two months. It was found that half of the caregivers used the pictorial instructions when administering the Amoxicillin syrup and the other half did not use these instructions. Pharmacists provide incomplete treatment instructions, and caregivers use past experiences and their perceptions and understandings of the disease and treatment to fill in the gaps. For caregivers who used the pictorial instructions, these instructions reinforced the oral instructions, past experience and their perceptions and they almost all of them gave the medicine correctly. Caregivers who did not read the pictorial instructions had no such reinforcement and all of them gave the medicine incorrectly. Furthermore, the findings indicate that awareness of the importance to complete a treatment course was a motivating factor for caregivers to follow treatment instructions. The findings suggest that pictorial medicine instructions that contain an explanation for why to adhere could be a low cost intervention to increase adherence to Amoxicillin syrup to treat childhood pneumonia in Kenya.