Eric Morrison
Country: Canada
Background:
Research Project: Medical Treatment Adherence Among Street, Platform, and Slum Children in Kolkata
BACKGROUND: This qualitative study aims to bridge the gap in the adherence literature as there are no known studies on medical treatment adherence for street, platform, and slum children (SPSC).
The purpose of this study was to explore the barriers to adherence for SPSC and identify interventions and recommendations of NGOs and physicians who have significant work experience with SPSC.
METHODS: 11 key informant interviews were conducted with physicians and NGO workers having at least one year of experience working with SPSC. Participants were asked questions concerning barriers to adherence and recommendations to improve adherence for SPSC according to a semistructured interview guide based upon related adherence literature. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed by the principal investigator using a four-level coding process according to Hahn (2008) using Microsoft Word and Microsoft Excel.
RESULTS: Seven major themes were generated through the analysis: Awareness, Caregiver
Support, Characteristics of Therapies, Interactions with Health Care Providers, Mobility, Physical Vulnerability, and Systemic Infrastructure. Barriers concerning awareness and systemic infrastructure received the most emphasis from key informants. Caregiver support was found to be a crucial aspect of adherence for SPSC, especially for very young children. Mobility was an extremely important factor governing adherence through several of the themes. Poor interaction with health care providers to explain illnesses and treatment regimens was mentioned as a significant barrier to adherence for SPSC. Characteristics of therapies and physical vulnerability were also mentioned to influence adherence. Current interventions employed by NGOs to improve adherence included health awareness and access sessions with SPSC and their caregivers, as well as sensitization workshops for government hospital personnel, the police, and the Railway Protection Force (RPF). NGOs also provide free treatment and access to medical care, counsel SPSC and their caregivers regarding traumatic experiences and the importance of adherence, and conduct follow-up visits to monitor and encourage adherence practices. Structural links between NGOs, government hospitals, and security forces have improved health care support for SPSC, but more development in this area is needed. Other recommendations to improve adherence included improving health awareness and health care access awareness among SPSC and their caregivers through educational and behavioural interventions. Other recommendations included improving infrastructure in the government health care system, decreasing the cost of treatment for SPSC, improving access to treatment facilities, increasing the number of municipality clinics, increasing the number of workers conducting follow-up visits, and improving the attitudes and behaviours of government hospital personnel toward SPSC.
CONCLUSIONS: Many different types of barriers influence medical treatment adherence among SPSC. Caregiver support and mobility were determined to be the most crucial factors because they are closely connected to the other major barriers to adherence. A multipronged approach to managing adherence among SPSC with cooperation between medical, governmental, and law enforcement personnel is required to maintain high levels of adherence among SPSC.
Keywords: adherence/compliance, street children, India, poverty, homeless