Medication adherence: a review of policy and education in South Africa
- Authors: Nyoni, Cynthia Nomagugu
- Date: 2023-10-31
- Subjects: Patient compliance South Africa , Drugs Administration Study and teaching (Higher) , Pharmacist and patient South Africa , Pharmaceutical policy South Africa , Patient education South Africa , Medication adherence
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/419548 , vital:71653
- Description: Medication adherence is a patient's active and voluntary participation in following all the recommendations and instructions agreed upon with a health care provider such as a pharmacist. Adherence is a multidimensional phenomenon determined by the interplay of five factors: patient-related factors, socioeconomic factors, condition-related factors, health system-related factors, and therapy-related factors. Medication non-adherence is a problem in many countries, especially low to middle-income countries, including South Africa (SA). In low to middle-income countries, non-adherence is often worse due to insufficient health resources and inequities in access to health care. Medication adherence is a global problem and has raised the need for research and review. Many healthcare professionals, especially pharmacists, have an essential role in promoting medication adherence. This study described, explained and evaluated the policies in SA relating to the pharmacist's role in promoting medication adherence. Furthermore, it described medication adherence-related education at four universities in South Africa. The study was qualitative, and a two-phased approach was employed. In the first phase, a document analysis of the pharmacist’s role in supporting medication adherence was conducted as described in national policies and guidelines in SA. A total of 38 documents were analysed, including critical documents such as the South African Pharmacy Council Good Pharmacy Practice Manual and Associated SAPC rules (GPP) manual, National Drug Policy (NDP), Standard treatment guidelines (STGS) and Integrated Adherence Guidelines. The READ approach was used in conducting the document analysis and involved (1) preparing materials, (2) extracting data, (3) analysing data, and (4) distilling findings. The critical roles of pharmacists in medication adherence that were identified were in drug use, supply and management, dispensing, therapeutic drug monitoring, pharmacovigilance, pharmaceutical care, and special programmes like antimicrobial stewardship (AMS), multi-drug resistant tuberculosis (MDR-TB) care and antiretroviral treatment (ARV) and chronic conditions. In the second phase, in-depth interviews were conducted with lecturers to investigate and report on the inclusion of medication adherence and the teaching thereof in the curriculum of the Bachelor of Pharmacy Degree (BPharm) in pharmacy institutions in SA. Purposive sampling was used, and seven lecturers from four different institutions participated in the interviews. The interviews were conducted via Zoom® and were transcribed and analysed using thematic analysis. The teaching of medication adherence in the BPharm curriculum of the respective interviewed pharmacy institutions was explored. It was found that the topic of medication adherence was integrated into all subjects throughout the curriculum and not taught as a formal course. Although medication adherence is taught in many disciplines, it is predominantly in pharmacy practice in all institutions. The teaching methods identified included lectures, case studies, workshops, tutorials, practicals, readings, tasks, assignments and videos. The perceived effectiveness of the teaching methods was explored; also the time spent teaching medication adherence and the time efficiency. Student understanding, interest and engagement with the topic were explored and determined through their assessment performance and class attendance. In conclusion, from policies, the pharmacist's role concerning adherence is indirectly integrated into many other roles. It is often not distinguishable from that of other healthcare professionals and is often implied as part of a more generic role. Pharmacy students are educated on medication adherence and the skills and knowledge required to identify, monitor and support patient adherence to therapy. However, there is scope to increase the course content on medication adherence. There is a need to identify effective strategies for preparing pharmacists to assist patients in medication adherence. , Thesis (MPharm) -- Faculty of Pharmacy, 2023
- Full Text:
- Date Issued: 2023-10-31
- Authors: Nyoni, Cynthia Nomagugu
- Date: 2023-10-31
- Subjects: Patient compliance South Africa , Drugs Administration Study and teaching (Higher) , Pharmacist and patient South Africa , Pharmaceutical policy South Africa , Patient education South Africa , Medication adherence
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/419548 , vital:71653
- Description: Medication adherence is a patient's active and voluntary participation in following all the recommendations and instructions agreed upon with a health care provider such as a pharmacist. Adherence is a multidimensional phenomenon determined by the interplay of five factors: patient-related factors, socioeconomic factors, condition-related factors, health system-related factors, and therapy-related factors. Medication non-adherence is a problem in many countries, especially low to middle-income countries, including South Africa (SA). In low to middle-income countries, non-adherence is often worse due to insufficient health resources and inequities in access to health care. Medication adherence is a global problem and has raised the need for research and review. Many healthcare professionals, especially pharmacists, have an essential role in promoting medication adherence. This study described, explained and evaluated the policies in SA relating to the pharmacist's role in promoting medication adherence. Furthermore, it described medication adherence-related education at four universities in South Africa. The study was qualitative, and a two-phased approach was employed. In the first phase, a document analysis of the pharmacist’s role in supporting medication adherence was conducted as described in national policies and guidelines in SA. A total of 38 documents were analysed, including critical documents such as the South African Pharmacy Council Good Pharmacy Practice Manual and Associated SAPC rules (GPP) manual, National Drug Policy (NDP), Standard treatment guidelines (STGS) and Integrated Adherence Guidelines. The READ approach was used in conducting the document analysis and involved (1) preparing materials, (2) extracting data, (3) analysing data, and (4) distilling findings. The critical roles of pharmacists in medication adherence that were identified were in drug use, supply and management, dispensing, therapeutic drug monitoring, pharmacovigilance, pharmaceutical care, and special programmes like antimicrobial stewardship (AMS), multi-drug resistant tuberculosis (MDR-TB) care and antiretroviral treatment (ARV) and chronic conditions. In the second phase, in-depth interviews were conducted with lecturers to investigate and report on the inclusion of medication adherence and the teaching thereof in the curriculum of the Bachelor of Pharmacy Degree (BPharm) in pharmacy institutions in SA. Purposive sampling was used, and seven lecturers from four different institutions participated in the interviews. The interviews were conducted via Zoom® and were transcribed and analysed using thematic analysis. The teaching of medication adherence in the BPharm curriculum of the respective interviewed pharmacy institutions was explored. It was found that the topic of medication adherence was integrated into all subjects throughout the curriculum and not taught as a formal course. Although medication adherence is taught in many disciplines, it is predominantly in pharmacy practice in all institutions. The teaching methods identified included lectures, case studies, workshops, tutorials, practicals, readings, tasks, assignments and videos. The perceived effectiveness of the teaching methods was explored; also the time spent teaching medication adherence and the time efficiency. Student understanding, interest and engagement with the topic were explored and determined through their assessment performance and class attendance. In conclusion, from policies, the pharmacist's role concerning adherence is indirectly integrated into many other roles. It is often not distinguishable from that of other healthcare professionals and is often implied as part of a more generic role. Pharmacy students are educated on medication adherence and the skills and knowledge required to identify, monitor and support patient adherence to therapy. However, there is scope to increase the course content on medication adherence. There is a need to identify effective strategies for preparing pharmacists to assist patients in medication adherence. , Thesis (MPharm) -- Faculty of Pharmacy, 2023
- Full Text:
- Date Issued: 2023-10-31
Pharmacists’ attitudes and perception of using pictograms as a communication tool in practice
- Authors: Okeyo, Sam Juma
- Date: 2022-04-06
- Subjects: Picture-writing South Africa , Communication in public health South Africa , Pharmacists South Africa Attitudes , Health literacy South Africa , Patient education South Africa , Structural equation modeling , Theory of planned behavior
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/290693 , vital:56775
- Description: Pictograms, when used in conjunction with verbal and written information, are known to be effective in improving comprehension and recall of medicines information and in supporting communication between healthcare professionals and patients. However, pictograms are seldom used in routine pharmacy practice, and little is known about pharmacists’ opinions of pictograms and their intention to possibly incorporate pictograms into routine practice. This study aimed to investigate pharmacists’ opinions relating to pictograms as a communication tool, and, by applying the Theory of Planned Behaviour (TPB), to explore their intention to use pictograms in pharmacy practice as well as the barriers to their use. The quantitative study design involved a two-phase approach. Phase 1 was a descriptive, cross-sectional online national survey of pharmacists. The 70-item, four-section survey was primarily based on the constructs of TPB, which included attitude, intention, subjective norm, and perceived behavioural control. The last survey section recruited pharmacists for a follow-up Phase 2 survey. Following a pilot study, the survey was emailed to all pharmacists registered with the South African Pharmacy Council. Descriptive statistics for survey items were generated. Pearson correlation investigated the correlation between participant characteristics, familiarity with pictograms and use of pictograms in practice. Structural Equation Modelling (SEM) determined if there was a significant relationship between attitude, subjective norm and perceived behavioural control with intention to use pictograms. A total of 426 pharmacists responded to the Phase 1 survey. Most pharmacists were familiar with the term ‘pictogram’; however, over three-quarters of pharmacists had never observed pictograms being routinely used in a pharmacy setting. When presented with pictograms designed for a low health literate population, most pharmacists thought the design and overall look of the pictograms would be easy for most patients in South Africa to understand (71.6 ± 24.0). Two-thirds of pharmacists (65.0 ± 30.6), felt that pictograms should be used for all patient populations. More than 85% of pharmacists agreed that pictograms should be used for dosage instructions, auxiliary or additional information, warnings, and storage instructions. However, fewer (58-68%) felt that indication, side effects and risk communication information should be accompanied by pictograms. Pharmacists demonstrated positive attitudes towards using pictograms in practice (mean = 4.2 ± 0.9; range: 1 - 5), while perceived behavioural control (mean = 3.0 ± 1.2; range: 1 - 5), subjective norm (mean = 3.8 ± 1.0; range 1 - 5) and intention (mean = 3.3 ± 1.0; range 1 - 5) were all neutral. Attitude (β = -0.25, p < 0.117), however, was not a significant predictor of intention while perceived behavioural control (β = -0.83, p < 0.000) presented with a significant negative correlation with intention. Subjective norm (β = 0.57, p <0.000) was the strongest predictor of intention. Scale reliability ranged from 0.770 to 0.865 for the TPB constructs. Phase 2 aimed to expand on, and further investigate Phase 1 findings relating to current and intended pharmacist behaviour and opinions concerning pictogram usage. As Phase 2 looked to investigate issues in greater depth, questions included open-ended response options. The survey link was emailed to all pharmacists who had voluntarily offered to participate in Phase 2. Frequency data for all questions were generated, and content analysis was undertaken for the free-response comments offered by pharmacists. A total of 35 pharmacists responded to the Phase 2 survey. Most pharmacists who routinely used pictograms initiated their use with support from pharmacists’ colleagues (8/12) and their supervisor/manager (6/7). Pharmacists who stated their intention to use pictograms anticipated receiving support from their pharmacists' colleagues (18/23) and manager/supervisor (15/23). All 12 pharmacists who were routinely using pictograms reported a positive effect on patient communication, with almost all having encountered no negative aspects of using pictograms (11/12). Almost all pharmacists intending to use pictograms could foresee benefits from their use (22/23). Misinterpretation of pictograms was a prevalent barrier common to both pharmacists routinely using pictograms and to those intending to use pictograms. Increased workload was regarded as a prevalent barrier only by pharmacists intending to use pictograms. This study was the first national study of pharmacists to investigate their opinion of pictograms and their use and to adopt a theoretical approach to consider pharmacist intention to use pictograms in routine pharmacy practice. Pharmacists generally expressed positive attitudes to pictograms but showed inadequate understanding of pictogram use. Pharmacists using pictograms reported the positive effect of pictograms on their patient communication, whereas those planning to use pictograms could foresee the benefits of using pictograms despite regarding increased workload as a barrier. As the strongest predictor of intention was subjective norm, this construct should therefore be targeted to motivate pharmacists to adopt the use of pictograms. , Thesis (MPharm) -- Faculty of Pharmacy, Pharmacy, 2022
- Full Text:
- Date Issued: 2022-04-06
- Authors: Okeyo, Sam Juma
- Date: 2022-04-06
- Subjects: Picture-writing South Africa , Communication in public health South Africa , Pharmacists South Africa Attitudes , Health literacy South Africa , Patient education South Africa , Structural equation modeling , Theory of planned behavior
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/290693 , vital:56775
- Description: Pictograms, when used in conjunction with verbal and written information, are known to be effective in improving comprehension and recall of medicines information and in supporting communication between healthcare professionals and patients. However, pictograms are seldom used in routine pharmacy practice, and little is known about pharmacists’ opinions of pictograms and their intention to possibly incorporate pictograms into routine practice. This study aimed to investigate pharmacists’ opinions relating to pictograms as a communication tool, and, by applying the Theory of Planned Behaviour (TPB), to explore their intention to use pictograms in pharmacy practice as well as the barriers to their use. The quantitative study design involved a two-phase approach. Phase 1 was a descriptive, cross-sectional online national survey of pharmacists. The 70-item, four-section survey was primarily based on the constructs of TPB, which included attitude, intention, subjective norm, and perceived behavioural control. The last survey section recruited pharmacists for a follow-up Phase 2 survey. Following a pilot study, the survey was emailed to all pharmacists registered with the South African Pharmacy Council. Descriptive statistics for survey items were generated. Pearson correlation investigated the correlation between participant characteristics, familiarity with pictograms and use of pictograms in practice. Structural Equation Modelling (SEM) determined if there was a significant relationship between attitude, subjective norm and perceived behavioural control with intention to use pictograms. A total of 426 pharmacists responded to the Phase 1 survey. Most pharmacists were familiar with the term ‘pictogram’; however, over three-quarters of pharmacists had never observed pictograms being routinely used in a pharmacy setting. When presented with pictograms designed for a low health literate population, most pharmacists thought the design and overall look of the pictograms would be easy for most patients in South Africa to understand (71.6 ± 24.0). Two-thirds of pharmacists (65.0 ± 30.6), felt that pictograms should be used for all patient populations. More than 85% of pharmacists agreed that pictograms should be used for dosage instructions, auxiliary or additional information, warnings, and storage instructions. However, fewer (58-68%) felt that indication, side effects and risk communication information should be accompanied by pictograms. Pharmacists demonstrated positive attitudes towards using pictograms in practice (mean = 4.2 ± 0.9; range: 1 - 5), while perceived behavioural control (mean = 3.0 ± 1.2; range: 1 - 5), subjective norm (mean = 3.8 ± 1.0; range 1 - 5) and intention (mean = 3.3 ± 1.0; range 1 - 5) were all neutral. Attitude (β = -0.25, p < 0.117), however, was not a significant predictor of intention while perceived behavioural control (β = -0.83, p < 0.000) presented with a significant negative correlation with intention. Subjective norm (β = 0.57, p <0.000) was the strongest predictor of intention. Scale reliability ranged from 0.770 to 0.865 for the TPB constructs. Phase 2 aimed to expand on, and further investigate Phase 1 findings relating to current and intended pharmacist behaviour and opinions concerning pictogram usage. As Phase 2 looked to investigate issues in greater depth, questions included open-ended response options. The survey link was emailed to all pharmacists who had voluntarily offered to participate in Phase 2. Frequency data for all questions were generated, and content analysis was undertaken for the free-response comments offered by pharmacists. A total of 35 pharmacists responded to the Phase 2 survey. Most pharmacists who routinely used pictograms initiated their use with support from pharmacists’ colleagues (8/12) and their supervisor/manager (6/7). Pharmacists who stated their intention to use pictograms anticipated receiving support from their pharmacists' colleagues (18/23) and manager/supervisor (15/23). All 12 pharmacists who were routinely using pictograms reported a positive effect on patient communication, with almost all having encountered no negative aspects of using pictograms (11/12). Almost all pharmacists intending to use pictograms could foresee benefits from their use (22/23). Misinterpretation of pictograms was a prevalent barrier common to both pharmacists routinely using pictograms and to those intending to use pictograms. Increased workload was regarded as a prevalent barrier only by pharmacists intending to use pictograms. This study was the first national study of pharmacists to investigate their opinion of pictograms and their use and to adopt a theoretical approach to consider pharmacist intention to use pictograms in routine pharmacy practice. Pharmacists generally expressed positive attitudes to pictograms but showed inadequate understanding of pictogram use. Pharmacists using pictograms reported the positive effect of pictograms on their patient communication, whereas those planning to use pictograms could foresee the benefits of using pictograms despite regarding increased workload as a barrier. As the strongest predictor of intention was subjective norm, this construct should therefore be targeted to motivate pharmacists to adopt the use of pictograms. , Thesis (MPharm) -- Faculty of Pharmacy, Pharmacy, 2022
- Full Text:
- Date Issued: 2022-04-06
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