The Training and Communication Package: Health Intervention Package to Improve Prescription Adherence among Patients and Caregivers
Creators: name: Udas, Summita
Publisher: name: Nature Awards for Inclusive Health Research
Year: 2025
Subjects: classificationCode: 420602
subject: Health equity

description: <b>Abstract</b>The Foundation for Innovative New Diagnostics (FIND)’s Antimicrobial Resistance (AMR) Diagnostic (Dx) Use Accelerator clinical trial developed a training and communication (T&amp;C) intervention package at the Oxford University Clinical Research Unit Nepal (OUCRU-NEPAL), to improve prescription adherence among patients and caregivers. The package included training for healthcare workers (HCWs) on effective communication of adherence messages to patients.Implementation occurred in two stages. HCWs received training during site initiation. Patients and caregivers in the intervention arm received adherence messages during initial consultations. HCWs discussed these messages with patients while providing prescriptions, supported by communication materials in the consultation space. The package aimed to enhance communication between HCWs and patients, educate them on antibiotic use, and indicate where to purchase antibiotics.The findings showed that the T&amp;C package helped patients to promote treatment adherence. Patients appreciated reminders, such as written notes, which prompted them to take their medications on time.<b>Introduction</b>Buddha Basnyat was the principal investigator of the FIND study in Nepal, and Summita Udas<b> </b>led the qualitative part. The study was conducted at Patan Hospital, the Civil Service Hospital, and the Nepal Korea Friendship Municipality Hospital. Damodar Gajurel and Gyan Kayastha were site investigators at the Civil Service Hospital and the Nepal Korea Friendship Municipality Hospital, respectively.Together with the social science team, we oversaw data collection, analysis, and interpretation. Our focus was on developing a T&amp;C package to improve prescription adherence. Our diverse scientific committee included OUCR-NEPAL’S director Abhilasha Karkey, microbiologist Sabina Dongol, consultants, physicians, and social scientists, to ensure rigorous evaluation of our approach. Community members provided feedback on communication clarity. This multidisciplinary scrutiny enhanced the intervention’s robustness and credibility, amplifying the validity of our findings.<b>Who should benefit?</b>In Nepal, the misuse of antibiotics poses a significant challenge, leading to bacterial resistance and strains on the healthcare system due to limited resources like clean water and infrastructure. This issue is compounded by economic and social factors, as financial constraints drive patients to seek cheaper alternatives for treatment, often resulting in incomplete courses of antibiotics. As a result, households face increased healthcare costs, pushing many into poverty and further burdening the already stretched healthcare system. Vulnerable groups like women, children, and the elderly are particularly affected, facing higher susceptibility to infections and limited access to healthcare.In 2019, Nepal witnessed 6,400 deaths attributable to AMR and 23,200 deaths associated with AMR, highlighting the severity of the issue. Nepal ranks 52nd out of 204 countries in terms of age-standardized mortality rates per 100,000 population associated with AMR.To address this multifaceted challenge, our study implemented a tailored T&amp;C package aimed at enhancing treatment adherence and combating AMR.Before the intervention, in-depth interviews (IDIs) were conducted with the participants to understand the perception of antibiotics /AMR and the adherence. The scientific committee rigorously evaluated the materials to ensure validity and reliability. HCWs in the intervention arm received training on delivering the T&amp;C package, emphasizing clear communication of messages to patients and caregivers during prescription provision.The T&amp;C package focused on facilitating dialogue between HCWs and patients, educating them on appropriate antibiotic use and acquisition.Feedback from interviews indicated mixed experiences among participants, but overall there was a positive perception of the package’s contribution to treatment adherence. Practical tools such as medicine bags were also seen as helpful reminders for medication adherence.The selection criteria for participants were consistent across the pre-intervention qualitative study, clinical trial, and post-intervention study.Participants included patients and caregivers attending the hospitals, caregivers of children and adolescents aged 6 months to 18 years, and adolescent and adult patients aged 13 years and older with fever and respiratory tract infections.The tailored intervention of the T&amp;C package showed promise in promoting adherence to treatment and addressing the challenges of AMR within Nepal’s healthcare system. However, ongoing efforts are needed to implement holistic strategies that consider economic disparities and social vulnerabilities to safeguard public health and well-being effectively.<b>Engagement</b>A community-based participatory method was adopted where patients, caregivers, and HCWs were involved in research design and development, recruitment of participants, the design of T&amp;C packages, and the dissemination of results. IDIs were conducted by trained social scientists and research assistants. All IDIs were conducted in person, either face-to-face or—to minimize participant time at the hospital during coronavirus disease 2019 (COVID-19) outbreaks—by telephone.Participants provided written consent and engaged with research assistants in hospitals. Trust was built, ensuring an understanding of study objectives. Opportunities for feedback were offered, including one-on-one conversations and discussion platforms, integrating community perspectives. This fostered genuine community consent and ownership of engagement initiatives.A dedicated scientific committee was formed to ensure the accuracy and effectiveness of the T&amp;C package. This included the OUCR-NEPAL director, senior microbiologists, consultants, emergency physicians, social scientists, doctors, nurses, and a clinical trial officer. Their extensive knowledge of patients and patient behaviours enabled them to rigorously evaluate the content, methodology, and overall quality of the training materials.The clarity of language in the communication messages was assessed by a small number of community members. This meticulous review process by both professionals and community representatives ensured the robustness and reliability of the intervention, thereby enhancing the credibility and validity of the findings.To ensure that we addressed all aspects of healthcare accessibility, before the start of the clinical trial we engaged with the HCWs who received training on the study protocol and the delivery of the T&amp;C package. This aimed to ensure consistency in patient interaction and adherence to the trial’s procedures.