How to Investigate the Use of Medicines by Consumers
(2004; 98 pages) View the PDF document
Table of Contents
View the documentAcknowledgements
View the documentPreface
Open this folder and view contents1. Why study medicines use by consumers
Open this folder and view contents2. What influences medicines use by consumers
Close this folder3. How to study medicines use in communities
View the document3.1 Introduction
View the document3.2 Describing and identifying medicines use problems
View the document3.3 Study of documents
View the document3.4 Semi-structured interviews
View the document3.5 Focus group discussions
View the document3.6 Observation techniques
View the document3.7 Structured interviews
View the document3.8 Weekly illness recalls
Open this folder and view contents4. Prioritizing and analysing community medicines use problems
Open this folder and view contents5. Sampling
Open this folder and view contents6. Data analysis
Open this folder and view contents7. Monitoring and evaluating rational medicines use interventions in the community
View the documentBack cover
 

3.8 Weekly illness recalls

Weekly illness recalls are a useful method for determining how people actually treat common health problems and how often certain drug use practices occur. Using this method, household members are interviewed about illnesses occurring recently (in the past few weeks) and related medicine use. This method can be used to collect information on:

• illness-related medicine use
• sources of medicines
• sources of advice on medicines
• spending on medicines.


How to conduct weekly recalls

Answers on medicine use are most reliable when they concern actual illness cases (as opposed to hypothetical ones) and cover a short period of time. If respondents are asked to recall illness episodes, the best recall period is one week. In areas where respondents can read and write, a health calendar may be given to the households as a memory aid. The illnesses that occur during the study period can be noted on this calendar.

FAMILY HEALTH CALENDAR

     

Children, list names

August

Father

Mother

               

Friday

1

                 

Saturday

2

                 

Sunday

3

                 

Monday

4

                 

Tuesday

5

                 

Wednesday

6

                 

Thursday

7

                 

Friday

8

                 

Saturday

9

                 

Sunday

10

                 

Monday

11

                 

Tuesday

12

                 

Wednesday

13

                 

Thursday

14

                 

Friday

15

                 

Saturday

16

                 

Sunday

17

                 

Monday

18

                 

Tuesday

19

                 

Wednesday

20

                 

Thursday

21

                 

Friday

22

                 

Saturday

23

                 

Sunday

24

                 

Monday

25

                 

Tuesday

26

                 

Wednesday

27

                 

Thursday

28

                 

Friday

29

                 

Saturday

30

                 

Sunday

31

                 

 

Please fill in every day if a family member had, for example, cough, cold, diarrhoea, headache or anything else.

Note: Researchers should adapt this list to local health problems before giving out the Family Calendar


During the first visit to the households selected for the weekly illness recall, the researcher explains the aims of the research and asks the respondents if they want to participate in the study. The researcher can also explain to the respondent how to use a health calendar, if appropriate. The respondent should be told that the next visit will take place one week later, and that the illnesses occurring during that week should be recalled. It is important to stress that the research team will not provide medical aid. In past studies we have found that people tend to over-report illnesses if they expect that medicines will be given to them.

A sample questionnaire designed for such a household interview and the form to record the data are given below. They are adapted from ones used for a comprehensive study on community drug use that aimed at: quantifying self-medication patterns; drug provision channels; the appropriate use of medicines; and most specifically, the appropriate treatment of diarrhoea and acute respiratory infection episodes.

When conducting weekly illness recalls, you will need to decide how often the families should be visited. We suggest at least three times: once to explain the objectives of the study, and then twice more to interview them about illnesses occurring in the family and the treatments given. This means that the study will last at least three weeks. When visiting a family to recall illnesses the second time, you need to follow up on the illness cases recorded during the first visit. You may need to add treatments to the cases recorded during the first visit. During the last visit when you have established a certain level of rapport with the respondents, you can ask to see their medicine cabinets to find out more about the medicines they use in self-care.

You will also need to decide how many families you intend to interview and if you want to draw a representative population sample. Your sample size will be limited by budgetary constraints. To obtain a reasonable amount of information, we suggest that you interview at least 100 families. Often researchers focus on families with pre-school children as relatively they suffer a high burden of disease. This fact makes them an important target group for interventions. In the same way, you can purposely decide to sample households with elderly people, as this group consumes medicines regularly. If you do want to draw a representative sample for your study, make sure you consult a statistician (see Chapter 5 on sampling).

When people are ill, they have several options: they may do nothing (no treatment), seek traditional therapy, seek treatment from a health care provider, or self-medicate with medicine. Weekly illness recalls such as the example given in the box above provide you with reliable data on people’s therapy choice.

You can use the data on medicines used to describe:

• sources of medicines: give a frequency distribution for specified sources. You can also present these data in a diagram, as given in figure 3 in Chapter 2, “What Influences Medicines Use by Consumers”

• most popular medicines in self-medication: list the 10 top names and give their generic contents and cost

• most popular medicines used for specific health conditions: select a number of predominant health conditions (such as acute respiratory infections, diarrhoea and malaria), and list the top 10 medicines named.


More information on processing and analysis of data collected in weekly illness recalls is given in Chapter 6.

WEEKLY ILLNESS RECALL QUESTIONNAIRE

Note for the interviewers: This questionnaire is to be used for the weekly visits to the respondent-families. During the first visit explain that you are conducting this study to find out more about the health problems in the community, and the way they are treated. Explain that you will be visiting them once a week for three weeks, and that they can use the health calendar to fill in any illnesses that occur during the week. Explain that their information will be treated anonymously, and that their privacy will be respected. After explaining this, ask if they have any questions, and then ask the respondents if they are willing to participate in the study. If yes, ask them to sign the informed consent form.

You should fill in one illness form for each illness case identified, see next page.

1. Has anyone in your family been ill during the past week? If yes continue below.

2. Who was ill? How old is (s)he?

3. What did (s)he suffer from?(Write down local terms used by respondent).

4. Did you give any treatment? Specify: none, or if treatment was given, the type of treatment, Specify the names of home or traditional remedies, as well as any Western medicines given.

5. What is the effect of the treatment? (Probe for all types of treatment given).

For any pharmaceuticals given, ask:

6. Can I see the package of the medicine? Copy details of the medicine’s contents, if given on the package.

7. Ask about the dosage/duration: When did you start giving pharmaceutical medicine? How many days did you treat the problem? How many times per day did you give the medicine(s)?

For all treatments ask:

8. Who advised you to take the treatment?

9. Where did you get the treatment? How much did it cost per capsule, tablet or per bottle? (Specify the number of mg active ingredient per capsule or tablet. If the drug is a syrup specify the number of mg/ml active ingredient and the total number of ml in the bottle). If you had an injection who gave it?

   

ILLNESS FORM

Name of patient:

Illness suffered:
(write down terms used by respondent)

Date:

 

Interviewer:

 

Community:

Treatment:

Age patient:

 
 

1st treatment

2nd treatment

3rd treatment

4th treatment

Name of treatment

       

Effect of the treatment according to respondent

       

For pharmaceuticals give contents as written on package

       

Dosage form (tablet, capsule, syrup, etc.)

       

Duration of treatment in days, and number of doses/day (give start date in brackets)

       

Who advised?

       

Where obtained?

       

Cost per unit, specify mg per tablet, ml per bottle

       

Comments on appropriateness (to be made by pharmaceutical adviser to the study)

       

Specific strengths and weaknesses of weekly illness recalls

The main strengths of weekly illness recalls are:

• data can easily be quantified and compared with results of other studies (measuring the same variables, using similar questionnaires)

• a lot of data can be collected in a short time

• they provide information on actual illnesses, and actual treatment practices (as opposed to hypothetical ones).


The main weaknesses of weekly illness recalls are:

• the interviewer controls the discussion, and may influence the responses

• no data on other aspects of the problem (not contained in a question) are collected

• the reliability of responses may be low, because the interview is held in an “unnatural” manner

• the information on illness-related medicine use is collected, not on the use of vitamins, tonics and other medicines to promote health

• the information on less common health problems is lacking.


The need for triangulation

As mentioned in the introduction to this chapter, when conducting intervention-oriented studies, we intend to be efficient, flexible, participatory and interactive. The data are not collected for the sake of research, but as steps in a process towards the development and implementation of effective rational drug use interventions. We have seen that many different methods can be used. The selection of methods will depend on the research questions. Each method has strengths and weaknesses. To overcome these, it is best to combine methods. Observations, for example, can teach us what people do. Semi-structured interviews and FGDs teach us why people do what they do. The combination of various methods (usually three) to cross-check information is called ‘triangulation’. Table 2 overleaf gives an overview of the methods discussed above, by level of health care, including what the methods can be used for.

Additional reading

Abramson JH, Abramson ZH (1999). Survey methods in community medicine, 5th ed. Edinburgh, Churchill Livingstone.

de Zoysa J et al. (1988). Research steps in the development and evaluation of public health interventions. Bulletin of the World Health Organization, 76(2):127-133.

Debus M (1986). Methodological review: a handbook for excellence in focus group re search. Washington, DC, Academy for Educational Development, HEALTHCOM. (To re quest a free copy write to: BASICS, Information Center, l600 Wilson Blvd., Suite 300, Arlington, VA 22209, e-mail tperez@basics.org).

Hudelson PM (1994). Qualitative research for health programmes. Geneva, World Health Organization. WHO/MNH/PSF/94.3.Rev.l.

Ross-Degnan D et al. (1996). The impact of face-to-face educational outreach on diarrhoea treatment practices in pharmacies. Health Policy and Planning 11(3):308-318.

Zimmerman M, Newton N, Frumin L, Wittett S (1996). Developing health and family planning print materials for low-literate audiences. Revised ed. Washington, PATH.

WHO and HAI (2003) Medicine prices: a new approach to measurement. Geneva, World Health Organization and Health Action International. WHO/EDM/PAR/2003.2.

Table 2. Overview of quantitative and qualitative methods to collect information on drug use by consumers

DATA SOURCE

TYPE OF METHODS

USEFUL TO COLLECT DATA ON:

Households Homes

Weekly illness recalls

• illness-related medicine use
• sources of treatments
• sources of advice/information on medicines
• perceived effects of medicines

 

Semi-structured interviews

• types of drug use practices
• advantages and disadvantages of medicine sources
• perceived drug use problems
• why medicines are used irrationally

 

Inventories of medicine cabinets

• commonly used medicines
• what medicines are used for
• where medicines are obtained/who gave advice
• experiences with medicines
• costs of medicines

Community

Inventory of community drug outlets

• commonly sold medicines
• information provision on medicines
• cost of medicines

 

Focus group discussions

• types of drug use practices
• perceived effects of medicines
• perceived drug use problems
• division of drug consumption roles
• perceived quality of care in health institutions
• sources of medicines, and perceived advantages and disadvantages of each
• source of information on medicines

Health institution

Review of patient records

• quality of health worker prescribing by facility

 

Structured observations

• information provided to patients
• quality of health worker prescribing

 

Exit interviews

• what people actually remember about prescriptions they received some time ago
• the prescriptions they received

 

Simulated client visits

• types of medicines prescribed/sold
• information given by the health worker/drug seller

 

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