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Original Research

A Qualitative Examination of Secondary Prophylaxis in Rheumatic Heart Disease: Factors Influencing Adherence to Secondary Prophylaxis in Uganda

Authors:

Daniel M. Huck,

School of Medicine, Case Western Reserve University, Cleveland, OH, US
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Haddy Nalubwama,

School of Public Health, Makerere University, Kampala, UG
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Chris T. Longenecker,

Division of Cardiovascular Medicine, University Hospitals, Cleveland, OH, US
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Scott H. Frank,

Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, US
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Emmy Okello,

Uganda Heart Institute, Mulago Hospital, Kampala, UG
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Allison R. Webel

Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, US
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Abstract

Background: Rheumatic heart disease (RHD) is the most common cause of heart disease amongUgandans age 15 to 49 years. Secondary prophylaxis with monthly injection of benzathine penicillin is effective in preventing recurrence of acute rheumatic fever and worsening of RHD, but adherence rates are poor in Uganda.

Objectives: This study sought to identify health behaviors, attitudes, and health care system factors that influence adherence to RHD secondary prophylaxis.

Methods: We conducted 5 structured focus groups with 36 participants onmonthly penicillin injections for RHD in Kamplala, Uganda. Transcripts were analyzed using qualitative description analysis and health behavior models.

Results: Most participants were female (64%), from an urban area (81%), and had family income less than US$1 daily (69%). Ages ranged from 14 to 58 years. Median prophylaxis duration was 1.42 years and 58% were adherent (≥80% of injections). Key facilitators include perceived worsening of disease with missing injections, personal motivation, a reminder system for injections, supportive family and friends, and a positive relationship with health care providers. Barriers to adherence include lack of resources for transportation and medications, fear of injection pain, poor patient-provider communication, and poor availability of clinics and providers able to give injections.

Conclusions: We identified key facilitators and barriers to secondary prophylaxis for RHD from the patient perspective framed within the socioecological model. Our findings provide direction for intervention development to improve national RHD secondary prophylaxis.

Highlights

  • Benzathine penicillin G intramuscular injections (secondary prophylaxis) are the standard of care to prevent the recurrence of acute rheumatic fever and prevent worsening of rheumatic heart disease.
  • Adherence rates to secondary prophylaxis are poor in Uganda and other developing nations.
  • Studies about factors associated with adherence to secondary prophylaxis are few, particularly in Africa.
  • Our study identifies key facilitators and barriers to secondary prophylaxis for rheumatic heart disease from the patient perspective framed within the socioecological model.
  • It provides direction for the development of individual and structural interventions to improve national rheumatic heart disease secondary prophylaxis.
How to Cite: Huck DM, Nalubwama H, Longenecker CT, Frank SH, Okello E, Webel AR. A Qualitative Examination of Secondary Prophylaxis in Rheumatic Heart Disease: Factors Influencing Adherence to Secondary Prophylaxis in Uganda. Global Heart. 2015;10(1):63–9. DOI: http://doi.org/10.1016/j.gheart.2014.10.001
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Published on 01 Mar 2015.
Peer Reviewed

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