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Background: Benzathine Penicillin (BPG) injections stop the progression of Rheumatic Heart Disease (RHD). Factors associated with BPG implementation and adherences have not been comprehensively assessed using the Behavior Change Model such as Capability, Opportunity and Motivation of Behavior (COM-B) and the Behavioral Change Wheel (BCW) framework.
Objective: The purpose of this mixed methods study was to assess the barriers and facilitators of BPG adherence among RHD patients at Tikur Anbessa Specialized Hospital using a COM-B model/BCW framework.
Methods: A concurrent mixed-methods study design was utilized. BPG adherence was considered optimal when RHD patients took 80% or more injections annually. All data collection and analysis were guided by the COM-B model and BCW framework. Quantitative data were collected through patient surveys and electronic medical records review. Qualitative data were collected using in-depth interviews RHD patients guided by COM-B model. Quantitative data were analyzed using descriptive statistics and predictors were assessed using binary logistic regression models. Data management and thematic analysis were carried out using Braun and Clark’s approach for qualitative data. Data integration was jointly displayed for the key findings from both quantitative and qualitative methods.
Results: The quantitative study included 346 RHD patients, while 21 RHD patients completed in-depth interviews. BPG adherence was 72%. Shorter distances from BPG injection centers and beneficial BPG prophylaxis perception facilitated BPG adherence among RHD patients using a quantitative method. The in-depth qualitative interviews revealed that family support, closer residence to BPG injection centers, health insurance coverage, and perception of BPG effectiveness facilitated BPG adherence. Data integration showed that shorter distances to BPG injection centers and beneficial BPG prophylaxis perceptions facilitated adherence among RHD patients.
Conclusions and recommendations: BPG adherence was suboptimal to reverse or slow RHD progression. Since shorter distances to BPG injection centers was associated with greater adherence, decentralized injection centers may be beneficial. Improving community education on the importance of BPG injections in RHD control may address the BPG prophylaxis perception gap. Evidence-based implementation strategies are needed in Ethiopia especially in areas where accesses to BPG injection sites are limited to improve patient outcomes.
