ASSESSING THE STRATEGIES USED BY COMMUNITY
PHARMACIES TO PROMOTE PATIENT ADHERENCE TO
MEDICATION INNAKIVUBO LUBAGA DIVISIONKAMPALA
BY
NABONGO JEREMIAH
UAHEB/029/043/17/18
MARCH, 2020
ASSESSING THE STRATEGIES USED BY COMMUNITY
PHARMACIES TO PROMOTE PATIENT ADHERENCE TO
MEDICATION INNAKIVUBO LUBAGA DIVISION
BY
NABONGO JEREMIAH
UAHEB/029/043/17/18
A RESEARCH REPORT SUBMITED IN PARTIAL FULFILLMENT OF
THE REQUIREMENT FOR THE AWARD OF A DIPLOMA IN
PHARMACY OF THE UGANDA ALLIED HEALTH EXAMINATIONS
BOARD
MARCH, 2020
2
DECLARATION
I hereby declare to the best of my knowledge that this research proposal is a product of my own
efforts and that it has never been submitted either in partial or wholly to any other institution for
any purpose and views expressed here are mine unless otherwise stated where has been the case
acknowledgement has been quoted.
Signature………………………….Date…………………………….
NABONGO JEREMIAH
(INESTIGATOR)
i
APPROVAL
This research report “A STUDY TO ASSESS STRATEGIES USED BY COMMUNITY
PHARMACIES TO PROMOTE PATIENT ADHERENCE TO MEDICATION IN NAKIVUBO
LUBAGA DIVISION KAMPALA.
Signature………………….Date……………………
Mr. MUSA NYAGO
(SUPERVISOR)
ii
DEDICATION
I dedicate this work to my dad and mum Mr. and Mrs. Kirabe for they have fought tooth and nail
to ensure my success throughout my life.
iii
ACKNOWLEDGEMENT
I thank the almighty God for the utmost support throughout this journey, for comforting me,
giving me the courage and strength to accomplish this study.
I also thank my supervisor Mr. NYAGO MUSA (Bpharm) for being such a dedicated supervisor
during the entire period of study despite the inconveniences of COVID 19.
Special appreciation goes to my family especially dad and mum Mr. and Mrs. Kirabe who have
ben thereto support me financially and spiritually during this study period.
Last but not least, my research group mates that helped with guidance and corrections whenever i
needed their help.
iv
TABLE OF CONTENTS
DECLARATION............................................................................................................................ i
APPROVAL .................................................................................................................................. ii
TABLE OF CONTENTS ............................................................................................................. v
LIST OF ABBREVIATIONS ..................................................................................................... ix
DEFINITION OF OPERATIONAL TERMS ............................................................................ x
CHAPTER ONE ........................................................................................................................... 1
INTRODUCTION......................................................................................................................... 1
1.0 Introduction ............................................................................................................................. 1
1.1 Background of the study ........................................................................................................ 1
1.2 Statement of the problem. ...................................................................................................... 2
1.3 General objective .................................................................................................................... 3
1.3.1 Specific objectives. ............................................................................................................... 3
1.3.2 Research questions ............................................................................................................... 3
1.4 Significance of the study ......................................................................................................... 4
1.5 Scope of the study.................................................................................................................... 4
1.6 Conceptual framework ........................................................................................................... 5
CHAPTER TWO .......................................................................................................................... 6
LITERATURE REVIEW ............................................................................................................ 6
2.0 Introduction. ............................................................................................................................ 6
2.1 How directly observed treatment promotes patient adherence to medication. ................ 6
2.2 How do communication techniques promote patient adherence to medication ............... 7
2.3 How does modification of patient beliefs by pharmacy practitioners promote adherence
to medication. ................................................................................................................................ 8
CHAPTER THREE ...................................................................................................................... 9
METHODOLOGY ....................................................................................................................... 9
3.0 Introduction ............................................................................................................................. 9
v
3.1 Study area ................................................................................................................................ 9
3.2 Study design............................................................................................................................. 9
3.3 Study population ..................................................................................................................... 9
3.4 Sample size determination ..................................................................................................... 9
3.4.1 Inclusion criteria ................................................................................................................ 10
3.4.2 Exclusion criteria ............................................................................................................... 10
3.5 Sampling technique............................................................................................................... 10
3.6 Sampling procedure .............................................................................................................. 10
3.7 Data collection tools .............................................................................................................. 10
3.8 Data collection method ......................................................................................................... 10
3.9 Data collection procedure..................................................................................................... 11
3.10 Piloting the study................................................................................................................. 11
3.11 Quality control .................................................................................................................... 11
3.12 Data analysis and presentation .......................................................................................... 11
3.14. Ethical consideration ......................................................................................................... 11
3.15. Study limitations ................................................................................................................ 12
3.16. Dissemination of results ..................................................................................................... 12
REFERENCES ............................................................................................................................ 31
APPENDICES ............................................................................................................................. 34
APPENDIX I: CONSENT FORM ............................................................................................ 34
APPENDIX II: QUESTIONNAIRE ......................................................................................... 35
APPENDIXIII: WORK PLAN .................................................................................................. 40
APPENDIXIV: PROPOSED BUDGET ................................................................................... 41
vi
LIST OF TABLES
Table 1: Table showing demographic of respondents………………………..
Table 2: A table showing
Table 3: Table showing
vii
LIST OF FIGURES
Figure 1:
Figure 2:
Figure 3:
Figure 4:
Figure 5:
Figure 6:
Figure 7:
Figure 8:
viii
LIST OF ABBREVIATIONS
ADEs
:
Adverse drug events
ADRs
:
Adverse drug reactions
CDC
:
Centre of Disease Control
DOT
:
Directly observed treatment
DR
:
Drug resistance
HCP
:
Healthcare Provider
MOH
:
Ministry of health
MRD
:
Multi drug resistance
UCG
:
Uganda Clinical Guidelines.
USP
:
United States pharmacopoeia
WHO
:
World Health Organization
ix
DEFINITION OF OPERATIONAL TERMS
Adherence: Is the act of sticking to treatment and clinical appointments
Attitude: This characteristic defines the power of perceiving something without seeing
Co-infection: these are other infection that arises in presence of the other infection.
Communication techniques; theses will majorly be verbal (involves speaking and listening) or
nonverbal (involves written information).
Medical
instruction:
Verbal
or
written
information
given
to
the
patienttoguidethemontheuseoftheirprescribeddrugsoranyotherinformationregardingtheirhealth
Patients counseling: this is a discussion between the healthcare provider and patient that involve
passing on information about drug use, possible side effect, drug interaction and drug
combinations so as to promote patients’ adherence to treatment.
Relapse: is a situation characterized by recurrent episodes of a disease even when one completed
the previous course of treatment.
Side effects: Is any response to the drug that is noxious and unwanted that occurs at doses
normally administered to humans for prophylaxis, diagnosis or treatment.
x
ABSTRACT
The major objective of the study was to assess the strategies used by community pharmacies to
promote patient adherence to medication in Nakivubo Lubaga Division Kampala District.
The specific objectives were to assess how DOT, communication techniques, and modification
of patients’ beliefs by pharmacy practitioners promotes adherence to medication.
A community based cross sectional descriptive study was carried out in different community
pharmacies in Nakivubo Lubaga Division Kampala District with a target population of thirtyseven respondents and I managed to get all the thirty-seven respondents who were all aged above
eighteen years of age using a semi structured questionnaire.
Data was collected on two days of the week that is on Saturday and Sunday when the pharmacy
practitioners were not so occupied with patients for a period of one month. Data is presented in
form of frequency tables, bar graphs, pie charts and narratives.
From the study, the major cause of non-adherence to medication were reluctance in performing
DOT at the community pharmacies due to the overload of patients 60%, failure to modify
patients’ beliefs towards their medication adherence 30%, inconsistence in the communication
techniques used since some times the pharmacy practitioners are pressurized by their employers
to mind more about making more sales than spending much time working on a patient hence
communicating less , and leaving out vital information that the patient would require most 10%
was also another cause of non-adherence.
The drug regulatory body in conjunction with the management bodies of the pharmacies should
carryout continuous medical supervision of the community pharmacies to ensure that enough
space is availed at the pharmacy premises and also the slots for the students enrolling for courses
in pharmacy should be increased at high institutions of learning. This will counteract the
challenge of limited number of pharmacy dispensers.
xi
CHAPTER ONE
INTRODUCTION
1.0 Introduction
This chapter is composed of the background, statement of the problem, general and specific
objectives, research questions, significance of the study, justification, scope of the study and the
conceptual frame work.
1.1 Background of the study
Adherence to medication is defined as the extent to which individuals take their medication as
prescribed. (Rachel Ann Elliot, 2016). Adherence reduces with time from initial prescription. In
depression, adherence was reported to drop from 95.5% to 52.6% over a one-month period.
(Saragoussi D, 2010). According to(MR, 2009)extensive research has shown that no matter how
knowledgeable the clinician maybe, if he or she is not able to open a good communication with the
patient, he or she may be of no help.
The institute of medicine (IOM) report on health professions and training has identified that doctors
and other health professions lack adequate training in providing high quality health care to patients
according to (Institute of medicine, 2003). Chronic illness is a significant worldwide health problem,
with the number of people affected steadily increasing. World health organization(WHO) data shows
that uncontrolled rose from 600million people to near 1billion from 1980-2008 and in similar period
the number of people with diagnosed type2 diabetes mellitus rose from 108-422 million(World health
organization, 2018)
Personal beliefs about illnesses include both cognitive and emotion representation,congnitive beliefs
include five core domains(1)”Identity “describes peoples beliefs about the level of illness and
symptoms, and sets out the targets for change(such as to eliminate symptoms)”(2)”Timeline refers to
people’s perceptions of the duration of illness, including symptoms and recovery”(3)”Consequences,
Refers to beliefs the serious of the diseases and the impacts on daily life;(4)”Control refers to
perceptions about the amenability of the illness to being cured, invented or treated;(5)”Causes, Refers
1
to people’s perception of the possible causes of their condition.Emotion representation are the fillings
that arise as a result of illness such as anxiety or depression((Aujla N, 2016)
Therefore,it’s because of the above background that the researcher seeks to assess the strategies used
by community pharmacies to promote patient adherence to medication in community pharmacies in
Nakivubo-Kampala.
1.2 Statement of the problem.
Failure to persist to a medicament represents an important barrier to achieving optimum patient
outcomes,(Sarab M, 2015). A number of rigorous reviews have found that in developed countries,
adherence among patients suffering from chronic diseases averages only 50%. (Sulbaran T, 2000).
The magnitude and impact of poor adherence in developing countries is assumed to be even higher
given the paucity of health resources and inequities in access to health care. A study that was carried
out revealed that in China, Gambia, and Seychelles only 43%, 27%, and 26% respectively of the
patients with hypertension adhered to their drug regimen (Waeber B, 2000). This represents a
tremendous challenge to population health efforts where success is determined primarily by
adherence to long term therapies.
In sub-Saharan Africa (SSA) the burden of disease is expected to double for both hypertension and
diabetes by 2025 and 2035 respectively,(Guariguata L, 2014). The number of people with diabetes is
predicted to increase by 166.9% between 2013 and 2023 outpacing most other countries.
A study conducted in Nakaseke district, on strategies used to promote patient adherence in Uganda
shows that a result replicated several findings from other settings, and identified some previously
undocumented challenges including patients knowledge gaps regarding the preventable aspect of
hypertension and diabetes mellitus, patients’ mistrust in the Ugandan health care system rather than in
individual health care providers and skepticism from both health care providers
and patients
regarding a potential role for Village Health Teams in hypertension and diabetes mellitus
management. (Chang H. Hawley, 2019)
2
In Nakivubo community pharmacies the pharmacy practitioners have tried their best to improve on
the patients knowledge and dispensing process activities by simplifying medication regimens,
involving caregivers(with permission from the patient), imparting appropriate knowledge about
patients’ medicine among others, but due to the drug resistance as a result of non adherence that has
been reported in Uganda this has called for the study to assess the different strategies that are used by
community pharmacies to promote patient adherence to medication and these will include Directly
observed treatment, communication techniques (verbal and nonverbal) and modification of patient
beliefs towards their medication.
1.3 General objective
To assess the strategies used by health workers in community pharmacies to promote patient
adherence to medication.
1.3.1 Specific objectives.
1. To assess how DOT, promote patient medication adherence.
2. To assess how communication techniques used by pharmacy practitioners promote adherence.
3. To assess how modification of patient beliefs by pharmacy practitioners promotes patient
adherence.
1.3.2 Research questions
1. Did use of directly observed treatment promote patient adherence to medication?
2. Did use of communication techniques promote patient adherence to medication?
3. Did modification of patient beliefs by pharmacy practitioners promote adherence to
medication?
3
1.4 Significance of the study
1. The contribution towards DOT about adherence to medication in Nakivubo would be of great
importance towards eradicating of resistance to medication secondary to non adherence to
medication.
2. The study provided data on key communication skills that are more preferred by patients and seen
to bring about more understanding and adherence to medication by patients.
3. The study improved the researcher’s knowledge and also used as a partial fulfilment of the award
of Diploma in pharmacy by Uganda Allied Health Examination Board (UAHEB).
1.5 Scope of the study
The study was conducted in community pharmacies around Nakivubo-Lubaga division in Kampala
District-Uganda.
This study sought to assess pharmacy interventions and programs that are intended to enhance
medication adherence among patients attending to community pharmacies in NakivuboLubaga
division. It was confined to factors affecting the use of medicines as prescribed or professionally
recommended. The study sought to evaluate pharmacy professionals that will be present in the
community pharmacies in Nakivubo.
The study took a period of four weeks, each week targeting the two day in which the pharmacy
practitioners were not so occupied with patients.
4
1.6 Conceptual framework
INDEPENDENT VARIABLES
DEPENDENT VARIABLES
Directly observed
treatment


Care takers,
follow up by
pharmacy
professionals
Adherence to medication
Communication techniques

,,,,,

Verbal (active
listening and
providing clear direct
message)
non-verbal(sending
reminder via mail,
email or telephone)
Modifying beliefs
5
The illustration above shows the relationship
CHAPTER TWO
LITERATURE REVIEW
2.0Introduction.
This chapter reviews the work of previous researchers related to this study. It's arranged according to
the objectives of the study.
2.1 How directly observed treatment promotes patient adherence to medication.
In a study carried out in Senegal, about effectiveness of a strategy to improve Adherence to
Tuberculosis Treatment by(S Thiam, 2007) direct observation of treatment was delivered by a person
selected by the patient. Self-administration was not an option, patients who selected family members
as their direct observation of treatment supporter experienced greater cure rates and less default than
those selecting community health workers.
WHO has reported that more than 30 million patients with TB have been treated with its five-element
DOTS strategy, resulting in cure rates of greater than 80%(WHO/HTM/TB/2006, 2006). To our
knowledge, post treatment relapse rates have not been analyzed in any study used to support the
elimination of direct observation. In public health practice failure to ensure treatment observation has
been associated with a significantly increased risk of relapse, often compounded by the emergence of
drug resistance,(HT Quy, 2006).
6
In another study, WHO recently announced global management conditions, including DOT to reduce
the risk of acquiring drug resistance, and support of patient to increase adherence to treatment and
chance of cure (WHO/HTM/TB, 2015). However the value of DOT has been questioned in recent
systemic reviews in which it was suggested that DOT was unnecessary and disrespectful of patients,(J
Volmink, 2006). Both self-administered treatment and treatment observation by a family member
have been proposed as acceptable alternatives. We challenge the validity of these assertions.
Therefore DOT results into adherence to medication as regards to the reviews above.
A study in USA about Recommendations for providers on person-centered approaches to medication
to assess and improve medication adherence stated that Medication nonadherence is a significant
clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by
patients and their families, providers, healthcare systems, payers and society. Patient –centered care
(that is involving patients and their families in planning their healthcare) is increasingly emphasized
as promising approach for improving medication adherence, but clinicians education about what this
might look like in a busy primary care environment is lacking. They used a case study which
demonstrated key skills such as motivational interviewing, counseling and shared decision-making
for clinicians interested in providing patient centered care in efforts to improve medication adherence.
Such patient centered approaches held considerable promise for addressing the high rate of non
adherence to medication for chronic conditions.(Hayden B Bosworth, 2017)
2.2 How do communication techniques promote patient adherence to medication
A study in the US about Medication adherence stated that medication adherence among adults and
adolescents remains suboptimal. Former U.S surgeon General C. Everett Koop once stated, “drugs
don’t work in patients who don’t take them (Ho PM B. C., 2009). To help patients take their
medications, pharmacists must be conversant with communication techniques both verbal and nonverbal that can be used to improve adherence. Medication non-adherence has been recognized as a
challenge that primary care providers increasingly face in practice, and pharmacist assistance is
warmly welcomed.(Kvarnstrom K, 2018)
Types of- and reasons for-non adherence are diverse and complex. Patients may not believe that the
medication is necessary, may never begin taking it, or may take more or less than prescribed; they
may even prematurely stop taking it. To effectively increase patient adherence to medication
7
pharmacists must adjust their Approach based on the cause and type of non-adherence and on patient
specific needs. Tailored patient counseling that targets the underlying causes of non-adherence is one
method of helping patients increase the medication taking behaviors.(Hugtenburg JG, 2013)
In a study about utilizing a 3s (strategies, source and setting) approach to Understand the preferences
when addressing medication non-adherence in patients with diabetes in the united states, Patients
have specifically identified pharmacists as the source of medication education.(Unni EJ, 2019).
Therefore pharmacists have a key opportunity to address medication non adherence through patient
communication. The use of behavioral theory in patient education and counseling can inform and
improve medication adherence. Different studies of patients on antidepressant therapy have shown
non-adherence rates as high as 56%: Patients with schizophrenia and bipolar disorder have reported
non-adherence rates of up to 61% and 60% respectively.
In a study carried out in India among community pharmacists in the age group of 22 to 60 yearsof
both gender agreed that, patient counseling during communication is their professional obligation
with their major reason to promote patient satisfaction (43%), improved patient adherence and
compliance (7.5%), where (32%) of patients go with satisfaction which greatly promotes patient
medication adherence. The major barrios were mentioned as pharmacists’ inadequate knowledge and
confidence 78% during communication. Therefore regular continuous professional counseling
programes are the factors observed to motivate the pharmacists to offer patient counseling so as to
promote adherence and quick recovery.
AStudy in the United States shown that community pharmacies can improve adherence through
medication education and side effect monitoring.(Nelson L A, 2018), therefore when communication
is effectively made by the pharmacy professionals in community pharmacies especially in Nakivubo,
cases of non adherence to medication will be minimized. Therefore carrying out this research will be
vital in enabling to assess the verbal and non-verbal communication techniques used to promote
adherence to medication.
2.3 How does modification of patient beliefs by pharmacy professionals promote adherence to
medication.
A study that was carried out in Sudan revealed that Establishment of rapport, conveying genuine
interest in patients, building the patient confidence in healthcare system and good communication is a
8
critical part of the belief change process. However knowledge will not guarantee that change of belief
of a patient towards a given drug will occur. Effective belief consultation with providers encourages
patients to express their concerns and thereby improve on medication adherence.(Almahdi, 2014).
Beliefs about health and treatment may also interfere with medication adherence. In another study
that was carried out, it was found that when a health worker convinces people to believe in their
treatment, it helps them to follow the treatment recommendations helping them to believe in the
efficacy of the treatment. Listening to and discussing any negative attitudes towards treatment,
determining the role of the patient’s social system in supporting or contradicting elements of the
regimen, helping the patient to commit to adherence and to believe that they are capable of doing it,
being sensitive and aware of patient’s cultural beliefs and practices, and viewing treatment through a
cultural lens to make sure that recommendations do not conflict with cultural norms thereby targeting
patients’ needs, to individualize patient adherence andultimately optimizehealth outcomes. (M.
Robinson, 2011)
In a study conducted in Nigeriaabout use of complementary and alternative medicine forhypertension
by (Osamor PE, 2010)itwas discovered that most people believe thattraditional herbal medicines are
cheaper unlike allopathic ones therefore people use more of the traditional medicines as compared to
modern ones and the same applies to adherence. In a study carried out in Buikwe and Mukono
districts of Uganda about use of alternative medicine for hypertension it was found that 56.2% of
people had ever used alternative medicine whereas 28.6% were currently using alternative medicine
alone or in combination with modern medicine 50%. The use of alternative medicine was common
among patients with hypertension and usage was underpinned by the belief that alternative medicine
is more effective therefore there is need for open and clear modification in the patients beliefs
towards alternative medicine use by pharmacy professionals. (Fred Nuwaha, 2013). If the strategies
that are used to promote adherence to medication in Nakivubo community pharmacies are assessed, it
will help clear the air about the different poor perceptions about taking medicine hence improving on
medication adherence.
9
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter covers the study design, study area, study population, sample size determination,
sampling procedures, data collection tools, quality control, data analysis and presentation, ethical
considerations, study limitation as well as dissemination of results.
3.1 Study area
The study was conducted in Nakivubo community pharmacies in Lubaga division, Kampala districtUganda.
3.2 Study design
A cross sectional and descriptive study was used to conduct the due to the fact that it allows for
determination of predictors and outcome variables at the same point in times with no follow up of the
participants. The study involved use of cross-sectional design employing quantitative and quality
approaches. It was conducted by use of questionnaires and interviews which were administered by the
researcher to the correspondents. The research sought for the respondents’ opinion about the study
topic.
3.3 Study population
The target population was pharmacy professionals who were found in the different community
pharmacies in NakivuboLubaga division.
3.4 Sample size determination
ThesamplesizetobeusedwillbecalculatedaccordingtotheformulaofKishandLes;
n=
N/1+Ne2
Where;
n is the sample size to be estimated
N is the target population
9
e is the level of significance assumed to be 0.1
n= 60/1+ (60*0.12)
n=37.5
n=37 respondents
3.4.1 Inclusion criteria
The study involved pharmacy professionals especially those who accepted to take part in the study.
3.4.2 Exclusion criteria
The study excluded any other pharmacy professionals who were not in touch with patients like those
doing procurement and the other support stuff like cashiers and cleaners.
3.5 Sampling technique
The study population was sampled using cluster random sampling.
3.6 Sampling procedure
The researcher approached the pharmacy professionals that were found in the different community
pharmacies and asked some to take part in the study. The participants signed the consent forms and
were given questioners to fill. This procedure was done for different community pharmacies in
Nakivubo until thirty-eight correspondents were achieved.
3.7 Data collection tools
Data was collected using researchers administered questionnaires that consisted of close ended
questions written in simple language to facilitate collection of only necessary information from
respondents, questionnaire pens, notebook, a file folder, medical records were used to collect data.
3.8 Data collection method
Questionnaires were used to obtain the required data. They were prepared and pretested prior to the
study. The questionnaires were written in English since it was favourable.
10
3.9 Data collection procedure
The pharmacy practitioners were selected to be representative of the sample and were explained to
the relevance of this research and how important their information will be to my study. Each
participant was given a questionnaire and a pen. The researcher guided them at each section of the
questionnaire to enable them understand and provide correct answers relevant tothe questions. After ,
the questionnaires were collected from the pharmacy professionals, thanked for their cooperation and
taken for analysis.
3.10 Piloting the study
A similar study will be done on three participants who will be pharmacy professionals at
lifechekpharmacy at Ham shopping grounds Nakivubo-kampala. Adjustments in the questionnaires
were made to ensure quality of the results.
3.11 Quality control
The quality of the research was assured through the following; Adjustingtheinterviewquestionafter
pretesting,
only
pharmacy
professionals
wereinterviewedtominimizefalseinformation,theresearcherguidedtherespondentonhowtoanswerquesti
ons.Enoughtimewasgiventothe
pharmacy
professional
tofillthequestionnaires.Alltheseprecautionsandprocedureswere employedtoensurequalityofthe results
that wereobtained.
3.12 Data analysis and presentation
Only filled questionnaires were counted and arranged. This was done manually and then data was
entered into a computer. Frequency tables, graphs pie chart were drawn and results presented as
percentages while qualitative data was presentedinform of flow charts and explanatory text.
3.14. Ethical consideration
Ethical considerations were observed during the study. A letter of introduction from the school of
pharmacy was taken to the director incharge of public health kampala capital city authority which
introduced me to the different community pharmacies and the different pharmacy practitioners
perticipants were explained to the study before they participated in the study and a consent form was
11
signed before answering the questionnaire. In order to maintain confidentiality, the questionnaires did
not have a provision for inclusion of names. Answers from respondents were not shared for
whatsoever reason.
3.15. Study limitations
1. Insufficient funds to run the research activities of the study.
2. Limited time for data collection of the research study.
3. Presence of the pandemic disease in the community that was Corona virus.
3.14
Remedies to limitations.
1. I followed the proposed budget so as to avoid unnecessary expenses.
2. The researcher followed the work plan in order to utilize the limited stated time for the research.
3. Wearing of masks was inevitable to avoid contracting the deadly corona virus.
3.16. Dissemination of results
I produced one original copy of the report for Uganda Allied Health Examinations Board (UAHEB),
and three other copies out of the original which were disseminated in the following way; one to
Uganda Institute of Allied Health and Management Sciences-Mulago, another to the office of the
Director Public Health Kampala Capital City Authority and the third copy reserved for me.
12
CHAPTER FOUR
4.0 INTRODUCTION
This chapter presents findings on the study to assess the strategies used by community pharmacies to
promote patient adherence to medication in Nakivubo-Lubaga Division Kampala district.
The sample size consisted of a total of thirty-seven respondents. The results are presented according
to specific objectives and demographic data.
4.1DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
Theresearchclassifiedtherespondentsaccordingtodemographicfactorslikesex,
age,maritalstatusandreligion.Itwasimportantfortheresearchertoknowthesex
(gender) of the respondentsto know whethertherewas a relationshipbetween
Genderandpracticescarriedoutbypharmacypractitioners.Itwasalsoimportant
for the researcherto know theageofrespondentsinorderto know whether
respondentswereoldenoughtoparticipateinthestudy.Also,maritalstatuswas
importantbecausetheresearcherwasinterestedindrawingarelationshipbetween
maritalstatus and theireffectiveness in handling and communicating to patients.
13
Table1:Table showing demographic features of the respondents.
Variable studied
frequency
Percentages (%)
Male
17
45.9
Female
20
54.1
18-29
32
86.5
30-39
4
10.8
40-49
1
2.7
50 and above
0
Sex
Age
Marital status
Single
30
81.1
Married
5
13.5
Separated
2
5.4
Widow or widower
0
The results in the table show that majority of the respondents were females 20(54.1%) and 17(45.9%)
were Males.
Majority of the respondents 32(86.5%) were aged between 18 to 29, the other 4(10.8%) were aged
between 30-39 the rest, 1(2.7%) were aged between 40-49, while there were no respondents aged 50
and above.
Majority of the pharmacy professionals, 30(81.1%) were single, 5(13.5%) were married and the rest
2(5.4%), had separated while there was no respondent who was divorced.
14
4.2DOT as regards to patient adherence to medication.
It was important for the researcher to assess how the DOT by respondents affects patient adherence
to medication as this would help to determine the effect of DOT by pharmacy professionals or care
takers to patient medication adherence.
Figure 1: The pie chart below shows the most preferred DOT by patients which brings about
better adherence and quick recovery among patients.
20%
DOT by pharmacy professionals
DOT by Family member
80%
From the above graph, it is shown that majority, 30(80%) of the respondents agreed that DOT by a
family member brings about better medication adherence while a few, 7(20%) respondents said DOT
by pharmacy professionals brings about better medication adherence.
15
Figure 2: disclosing all drug information to the patients who come to the pharmacy.
The respondents were asked whether they felt free to disclose all information to the patient regarding
use of the drug.
33%
Yes
67%
No
From the above graph, it is shown that most of the pharmacy professionals,25(67%) do not feel free
to disclose all information regarding medication for the patients while the rest, 12(33%) would feel
fine with disclosing all details regarding the patients’ medication.
16
Result 2: shows different opinions of pharmacy practitioners as regards to DOT.
The respondents were asked whether regular administration of drugs to a patient by care takers
selected by the patient quickens curing period of a patient from a chronic illness.
From the above table, it is shown that majority 22(60%) of the pharmacy professionals agreed, others
10(28%) disagreed while 5(12%) were not sure that regular administration of drugs by care takers
selected by the patient quickens curing period.
Table2: Taking drugs without observation and guidance by a health worker or care giver may
result in overdose or under dose.
Taking drugs without the
Number of respondents
Percentage(%)
Agree
36
97.3%
Disagree
0
0%
Not sure
1
2.7%
observation and guidance of a
health worker or caretaker
may result in overdose or
under dose.
The above results show that 36(97.3%) of the pharmacy professionals agree that taking drugs without
observation and guidance by a health worker or care taker may result in overdose or under dose, very
few 1(2.7%) were not sure and there was no pharmacy professional who disagreed that taking
17
medication by a patient without observation and guidance by a health worker or care taker may result
in overdose or under dose.
Figure 3: The pie chart below shows the respondents who agree, disagree and those that are not
sure whether a patient can resume normal work after finishing their medications.
24.3%
41%
Agree
Disagree
Notsure
35%
From the above graph, it is shown that majority, 15(41%) of the respondents are not sure if the patient
will resume work normally after finishing their medication, 13(35%) agree that the patient can
resume work normally after medication while very few 9(24.4%) were not sure whether the patient
can resume work normally after their medication.
18
Figure 4: Pie chart showing whether DOT can reduce risk of acquiring drug resistance.
The respondents were require to agree, disagree or not sure whether DOT can reduce risk of
acquiring drug resistance.
13%
Agree
4; 11%
11%
Disagree
Notsure
76%
From the above figure, 28(76%) of the respondents admitted that DOT can reduce the risk of
acquiring drug resistance, 5(13%) disagreed that DOT can reduce the risk of drug resistance while the
rest 4(11%) were not sure whether DOT could reduce risk of drug resistance.
19
4.3 Modification of patients’ beliefs by pharmacy professionals towards medication adherence
This specific objective was necessary in order for the researcher to ascertain the influence of patients’
beliefs towards their adherence to their medications.
Table 3: shows whether modification of patients’ beliefs towards their medication playsa part in
positively changing their adherence to medication.
The respondents were asked whether modification of patients’ beliefs positively changes adherence to
medication.
Modification of patients’ beliefs
positively changes adherence to
medication
Number of respondents
Percentage(%)
Yes
36
97.3
No
1
2.7
The results in the above table shows that majority, 36(97.3%) admitted that modification of patients’
beliefs positively changes adherence to medication while 1(2.7%) said that modification of patients’
beliefs does not positively change patients’ medication adherence.
20
Figure 4: A column graph showing whether beliefs of a patient about their medication affect
their adherence.
The respondents were asked whether patients’ beliefs towards health and treatment affect their
adherence to medication.
35
30
25
20
respondents number
15
10
5
0
Yes
No
From the above graph, majority, 30(81.1%) of the respondents said patient beliefs towards
medication greatly influences their adherence to medication while only a few 7(18.9%) said patient
beliefs towards medication does not influence their adherence to medication.
The information below shows whether pharmacy professionals have ever encountered patients
who believe that herbs are better as compared to western medicine.
It is noticed that the majority, 31(83.8) of the patients believe that herbs are better than western
medication while the minority, 6(16.2%) disagreed.
21
Traditional herbal medicines are cheaper as compared to allopathic/ herbal medicines.
The respondents were asked whether traditional herbal medicines are cheaper as compared to
allopathic medicines. From the data collected majority, 36(97.3%) of the respondents admitted that
traditional herbal medicines are cheaper as compared to western medicines while a few, 1(2.7%)
disagreed.
4.4 Pharmacy practitioner’ communication techniques.
Table 5: showing challenges faced by patient.
The respondents were asked which challenge caused non adherence among patients.
Communication challenges
faced
Number of respondents
Percentage (%)
Lack of proper communication
between patient and health
professional causing
forgetfulness
20
54.1
Transport costs and cost of
drugs.
3
8.1
Refilling on time
10
27
Side effects faced
4
10.8
From the data above, majority, 20(54.1%) said lack of proper communication between patients and
pharmacy professionals mostly caused non adherence, 10(27%) admitted that refilling on time was a
challenge to patient adherence, 3(8.1%) said transport costs was a challenge to medication adherence
while the rest, 4(10.8%) said side effects faced by patients caused patient non adherence to their
medication.
Figure 5. The column graph below shows the highest level of education obtained by the
pharmacy practitioners.
22
70
60
50
40
30
20
10
0
Number of respondents
percentage (%)
Bachelors
Diploma
in
in
Pharmacy
Pharmacy
percentage (%)
Number of respondents
Others
From the information above its observed that majority of the respondents did not have qualifications
in pharmacy fields, while only a few respondents had a Diploma and a Bachelor in pharmacy.
23
MOST PREFERRED COMMUNICATION TACHNIQUE BY PATIENTS.
From the data collected it was found out that majority, 35(94.6%) preferred verbal communication
like listening and speaking while only a few, 2(5.4%) preferred non verbal communication like
writing.
ARE YOU GIVEN ENOUGH TIME AND PRIVACY WHEN COMMUNICATING WITH
PATIENTS
From the data obtained, majority 26(70.3%) of the respondents disagreed about being given enough
time when communicating with patients while the rest, 11(29.7%) admitted that enough time was
given to them.
SOME OF THE STRATEGIES USED BY PHARMACY PROFESSIONAL TO PROMOTE
PATIENT ADHERENCE.
From the study it was discovered that majority 20(54.1%) respondents show patients how to use their
medicines so as to promote adherence, 10(27.1%) of the respondents acknowledged patients of the
different side effects of their medicines, 4(10.8%) of the respondents identify barriers to medicine non
adherence and air them with the patients out while the rest 3(8.1%) give discounts due to financial
hardships faced by some patients so as to encourage adherence.
24
CHAPTER FIVE
DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS
5.0 Introduction
This chapter presents discussions, conclusions and recommendations on the study factors to assess
the strategies used by community pharmacies to promote patient medication adherence in Nakivubo
Lubaga Division community pharmacies. A sample of 37 respondents was considered.
5.1 Discussion
The discussions will follow according to the stated objectives, with the demographic factors being
considered first.
5.1.1 Demographic characteristics
The study showed that most of the patients were female. This is attributed to the fact that most
employers in community pharmacies prefer employing women due to their high level of loyalty and
order as opposed to most of the males. Also, females could be better sales personnel due to their more
attractive nature as opposed to males.
Most of the respondents were young adults; aged 18 to 29. This implies that the biggest proportion of
pharmacy professionals are young people; especially owing to the fact that employers prefer to
employ young energetic people as they will quickly execute the assigned tasks. There were fewer
older people because in most cases the older ones prefer to start their own businesses other than
dispensing, because it’s considered to be for the young and active ones.
The highest number of the respondents consisted of the single people because these would most likely
concentrate on their jobs without outside disturbances and pharmacy employers would prefer this
group. The second biggest group consisted of those that were married and this explains why
commitment to follow up patients to ensure adherence to their medication is poor since they are not
fully concentrated at work. Very few were separated and non was widowed therefore these had
enough time at work as the commitment back home is not so demanding.
25
5.1.2 DOT towards patient adherence to medication
The biggest proportion of the pharmacy professionals agreed on the fact that DOT by a family
member selected by the patient brings about desirable results as far as patient adherence to
medication and better cure rates is concerned. Since most of the pharmacy professionals are always
occupied with a lot of workload at the pharmacy, they also part time in some other hospitals, and also
due to the fact that the country generally has a small number of the pharmacy professionals, they do
not offer the desired services such as patient follow up to ensure that patients take their medications
so as to promote adherence. Therefore the idea of a care taker selected by the patient brings about
better adherence among patients especially on chronic medications. This agrees with the information
in literature review, which showed that direct observation of treatment was delivered by a person
selected by the patient. Self-administration was not an option, patients who selected family members
as their direct observation of treatment supporter experienced greater cure rates and less default than
those selecting community health workers. (S Thiam, 2007).
In addition, from the information obtained, results showed majority (97.3%) of the pharmacy
professionals agreed that taking drugs without observation and guidance by a health worker or care
taker may result in overdose or under dose,
The results also confirm that majority of the pharmacy professionals (76%) agree that DOT can
reduce risk of relapse and acquiring drug resistance by any patient that is on chronic illness
medications. Direct observation of treatment will involve the care taker or pharmacy practitioner to
ensure that a given patient has taken their medication in its right dosage and in its right frequency at
the right agreed upon time. This will also involve the care taker ensuring that the patient has had a
meal before they take their medication for the drugs that require food first or for the drugs which
require an empty stomach, the care taker should ensure that the patient takes the drugs before food to
ensure attainment of quicker curing rates so as to promote adherence to medicine by the patient. (HT
Quy, 2006)
26
27
28
29
30
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33
APPENDICES
APPENDIX I: CONSENT FORM
I am NABONGO JEREMIAH a pharmacy student at Uganda institute of allied health and
management sciences carrying out a study to “Determine strategies used by community
pharmacies to promote patient Adherence to medication. A Case Study in community
pharmacies around Nakivubo-Lubaga division.
The main objective of this study is to assess the strategies used by community pharmacies to promote
patient adherence to medication.
Participation in this study will take you about 5-10minutes.You are free to ask any question
concerning the study.
Study procedure
You have been identified to participate in this study and it really requires your consent. Your
participation is purely voluntary and therefore you are free to withdraw at any time of convenience.
Confidentiality
34
Your identification will not be disclosed and the information you give will be kept and taken as
confidential. The information obtained in the course of the study will only be communicated to the
research committee for examination and no one else without your written permission.
Consent statement
I have been informed of the study to assess the strategies used by community pharmacies to promote
patient adherence to medication in NakivuboLubaga Division, Kampala district.
I hereby give my informed consent to participate in this study.
…………………………,
………………………..
Respondent’s signature
…………………………,
…..…..……………
Researcher’s signature.
APPENDIX II: QUESTIONNAIRE
A QUESTIONAIRETOASSESS STRATEGIES USED BY COMMUNITY PHARMACIES TO
PROMOTE PATIENT ADHERENCE TO MEDICATION,A STUDY CASE IN NAKIVUBO
COMMUNITY PHARMACIES LUBAGA DIVISION.
This study is being carried out to assess strategies used by community pharmacies to promote patient
adherence to medication.
All information will be treated with confidentiality. Please feel free to respond and the result will be
used for academic purposes only.
Instruction
Please circle the most appropriate answer against question or fill in the blank spaces provided.
SECTIONA: SOCIO-DEMOGRAPHICCHARACTERISTICSOFTHERESPONDENT
1. How old are you?
a) 18-29yrs
b) 30-39yrs
35
c) 40-49yrs
d) Above50
2. What is your sex?
a) Male
b) Female
3. What’s your marital status?
a) Single
b) Separated/Divorced
c) Married
d) Widow/widower
SECTIONB: HOW DIRECTLY OBSERVED TREATMENT PROMOTES PATIENT
MEDICATION ADHERENCE.
1. Which DOT option brings about better adherence and quick recovery among patients taking
medications?
a). DOT by family member
b). DOT by medical profession.
2. Do you feel comfortable disclosing all information regarding medication prescribed to the care
givers instead of the real patient?
a) Yes
b) No
3. In each of the following tick under the level of agreement with your opinion on the following
statements.
STATEMENTS
AGREE
NOTSURE
36
DISAGREE
Regular administration of
drugs by care takers
selected by the patient
quickens period taken to
cure disease completely
Taking drugs without
observation and guidance
by a health worker or
care giver may result in
overdose or under dose.
After finishing your
treatment under DOT,
you can do your work as
usual.
DOT can reduce the risk
of
acquiring
drug
resistance.
Do u often observe and
follow up patients as they
take their medication?
C: MODIFICATION OF PATIENTS BELIEFS BY PHARMACY PRACTITIONERS
TOWARDS MEDICATION ADHERENCE.
1. Does modification of patients’ beliefs play a part in positively changing patients’ adherence to their
medication?
a) Yes
b) No
2. Do patient beliefs about health and treatment affect their adherence to medication?
a) Yes
b) No
37
3. Have you ever encountered a patient who believes that using herbs is better than taking the western
medicine?
a) Yes
b) No
4. Traditional herbal medicines are cheaper as compared to allopathic/western medicines.
a) Yes
b) No
SECTION D: PHARMACY PROFESSIONAL COMMUNICATION TECHNIQUES TO
ENSURE PETIENT ADHERENCE.
1. Which challenges do patients mostly face that result into non adherence to medication?
a) Forgetfulness
b) Transportation costs
c) Refilling on time
d) Side effects faced.
2. What is your highest level of education?
a) Bachelors in pharmacy
b) Diploma in pharmacy
c) others
3. Which of the communication skills is most preferred by patients?
a) verbal
b) Non verbal
4. Do you think enough time and some privacy is provided for you to interact with the patient?
a) Yes
b) No
5. What are some of the strategies that you use to ensure effective communication to patients to
ensure medication adherence?
a) Acknowledging patient of the side effects of the drug
38
b) Giving discounts due to financial hardships
c) Show patient how to use the drug
d) Identifying barriers to medication adherence
***********THANK YOU FOR YOUR ACTIVE PATICIPATION*************
39
APPENDIXIII: WORK PLAN
Person in charge
ACTIVITY
2019
Oct
2020
Nov
Dec
Jan
Feb
Topic
Mar
April
May
Researcher
identification
Approval of
Researcher and
selected topic
supervisor
Writing a
Researcher and
proposal
supervisor
Data
Researcher
collection
Data analysis
Researcher and
supervisor
Report
Researcher and
writing and
supervisor
submission
40
APPENDIXIV: PROPOSED BUDGET
Quantity
Unit cost
No.
Item
1
Stationary
Pens
5
500/=
2500/=
Papers
1ream
20,000/=
20,000/=
Rulers
1
1000/=
1000/=
Subtotal
2.
Total
23500/=
Secretarial services
Typing
proposal
and
20,000/=each
40,000/=
25,000/=
25,000/=
5000/=
25,000/=
report
3.
Printing
Photocopying
questionnaires
Binding of the proposal 5copies
and dissertation
Subtotal
4.
90,000/=
Communication To the
40,000/=
40,000
25,000/=
25,000/=
respondents
To
the
research
supervisor
Sub total
5.
65,000/=
Transport facilitation for
40,000/=
40,000
80,000/=
80,000/=
the researcher
6.
Meals
Lunch and refreshment
7
miscellaneous
50,000/=
Grand total
348,500/=
41