Library Portal | UWC Portal
    • Login
    Contact Us | Quick Submission Guide | About Us | FAQs | Login
    View Item 
    •   Repository Home
    • Faculty of Community and Health Sciences
    • School of Public Health
    • Research Articles (SoPH)
    • View Item
    •   Repository Home
    • Faculty of Community and Health Sciences
    • School of Public Health
    • Research Articles (SoPH)
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    A realist approach to eliciting the initial programme theory of the antiretroviral treatment adherence club intervention in the Western Cape Province, South Africa

    Thumbnail
    View/Open
    Mukumbang_A-realist-approach_2018.pdf (2.680Mb)
    Date
    2018
    Author
    Mukumbang, Ferdinand C.
    Marchal, Bruno
    Van Belle, Sara
    van Wyk, Brian
    Metadata
    Show full item record
    Abstract
    BACKGROUND: The successful initiation of people living with HIV/AIDS on antiretroviral therapy (ART) in South Africa has engendered challenges of poor retention in care and suboptimal adherence to medication. The adherence club intervention was implemented in the Metropolitan area of the Western Cape Province to address these challenges. The adherence club programme has shown potential to relieve clinic congestion, improve retention in care and enhance treatment adherence in the context of rapidly growing HIV patient populations being initiated on ART. Nevertheless, how and why the adherence club intervention works is not clearly understood. We aimed to elicit an initial programme theory as the first phase of the realist evaluation of the adherence club intervention in the Western Cape Province. METHODS: The realist evaluation approach guided the elicitation study. First, information was obtained from an exploratory qualitative study of programme designers’ and managers’ assumptions of the intervention. Second, a document review of the design, rollout, implementation and outcome of the adherence clubs followed. Third, a systematic review of available studies on group-based ART adherence support models in Sub-Saharan Africa was done, and finally, a scoping review of social, cognitive and behavioural theories that have been applied to explain adherence to ART. We used the realist evaluation heuristic tool (Intervention-context-actors-mechanism-outcome) to synthesise information from the sources into a configurational map. The configurational mapping, alignment of a specific combination of attributes, was based on the generative causality logic – retroduction. RESULTS: We identified two alternative theories: The first theory supposes that patients become encouraged, empowered and motivated, through the adherence club intervention to remain in care and adhere to the treatment. The second theory suggests that stable patients on ART are being nudged through club rules and regulations to remain in care and adhere to the treatment with the goal to decongest the primary health care facilities. CONCLUSION: The initial programme theory describes how (dynamics) and why (theories) the adherence club intervention is expected to work. By testing theories in “real intervention cases” using the realist evaluation approach, the theories can be modified, refuted and/or reconstructed to elicit a refined theory of how and why the adherence club intervention works.
    URI
    http://dx.doi.org/10.1186/s12874-018-0503-0
    http://hdl.handle.net/10566/3743
    Collections
    • Research Articles (SoPH) [306]

    DSpace 5.5 | Ubuntu 14.04 | Copyright © University of the Western Cape
    Contact Us | Send Feedback
    Theme by 
    @mire NV
     

     

    Browse

    All of RepositoryCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    View Usage Statistics

    DSpace 5.5 | Ubuntu 14.04 | Copyright © University of the Western Cape
    Contact Us | Send Feedback
    Theme by 
    @mire NV