评价在低收入环境中使用阿莫仙干混悬剂治疗儿童肺炎时，使用工作辅助工具和用户说明来提高用药依从性的效果：一项混合方法研究。

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.

机构信息

Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.

Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.

出版信息

BMJ Open. 2019 May 30;9(5):e024978. doi: 10.1136/bmjopen-2018-024978.

DOI:10.1136/bmjopen-2018-024978

PMID:31152030

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6549679/

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.

摘要

目的

我们开展了一项研究，评估使用工作辅助工具和简单的用户说明来提高儿童肺炎用阿莫西林分散片（DT）治疗的依从性。

设计

这是一项混合方法研究，于 2015 年 10 月至 2016 年 2 月分三个阶段实施。

地点

研究在孟加拉国的两个分区进行。

参与者

年龄在 2-59 个月的儿童的照顾者、卫生服务提供者以及国家和地区层面的利益攸关方。

干预措施

在一个分区引入了包括培训和工作辅助工具以及用户友好型说明的干预措施，而在对照分区则使用没有培训的标准阿莫西林 DT 包装和说明作为对照。

主要结果

2-59 个月儿童的照顾者在治疗儿童肺炎用阿莫西林 DT 时的依从行为。

方法

我们在干预分区进行了一项调查，共有 56 名照顾者参加，在对照分区有 38 名照顾者参加。我们还对 44 名卫生保健提供者和照顾者进行了深入访谈，以评估工作辅助工具和用户友好型说明，评估工具在干预分区的可行性、可用性和可接受性。

结果

在 5 天疗程中，干预分区的 32.1%（95%CI 23.1%至 41.1%）的照顾者和对照分区的 2.6%（95%CI 0.3%至 7.8%）的照顾者完全遵守了肺炎用阿莫西林 DT 的治疗方案。接受年龄适宜治疗的 12 个月以下儿童多于年龄较大的儿童。利益攸关方和卫生保健提供者认为这些工具的使用和纳入卫生系统是可行和可接受的。