Using a treatment partner and text messaging to improve adherence to psychotropic medication: a qualitative formative study of service users and caregivers in Cape Town, South Africa.
OBJECTIVE
Poor adherence to medications, including psychotropic medications contributes to the burden of disease. Mental health service users (MHSU) may also not attend follow-up appointments at their health care facilities where they could discuss adherence with their health care provider. This paper reports on preliminary qualitative research preceding a randomised controlled trial that aims to improve adherence to psychotropic medication and to follow up treatment visits. The intervention will entail the support of individuals with serious mental disorder by a treatment partner and short message service (SMS) text messaging.


METHODS
The preliminary research reported in this paper aimed to extract views about the intervention from both mental health service users (MHSU) and caregivers through focus group discussions and individual interviews. Data were analysed using ATLAS TI qualitative software.


RESULTS
The caregivers interviewed were all mothers of MHSU who took measures to encourage adherence. They held mixed opinions on whether the treatment partner should be a family member. Most participants expressed the view that due to living conditions, family members were natural treatment partners, but others stated that they would prefer a treatment partner who was not a family member. Similarly, while most MHSU supported the idea of a treatment partner, a minority were concerned that a treatment partner may potentially be too controlling and compromise their autonomy. The vast majority of participants supported SMS text messaging as a means of reminding MHSU to take their medication and attend follow-up appointments. One participant mentioned the importance of broader social inclusion issues that should be incorporated in the intervention.


CONCLUSIONS
Qualitative research may provide useful insights for the design of interventions of this nature related to social inclusion randomised control trials with its focus on adherence.
Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa.
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Mall
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Sibeko
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Temmingh
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Stein
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Milligan
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Lund
D000328:Adult; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services; D036301:Qualitative Research; D017010:Reminder Systems; D012944:Social Support; D013019:South Africa; D060145:Text Messaging