Health care workers tend to assume that patients follow the instructions and advice they are given about medicine use. The studies presented in this book are based on the view that consumers - especially those with chronic conditions - are the key decision-makers in medicine use. Various factors - at individual, household, community, health service institution, national and international levels - influence medicine use by consumers. Consumers may have very rational reasons to use medicines 'irrationally'. Interventions to improve rational medicine use should be based on a thorough analysis and understanding of these reasons.
Over recent years, a shared view on how to study the multi-level influences which shape individual medicine use behaviour has evolved between WHO, the Medical Anthropology Unit of the University of Amsterdam and KIT. The expertise of all three institutions together provide a unique multidisciplinary approach, by including public health, anthropological and health systems perspectives.
This chapter describes the development of the Promoting Rational Drug Use in the Community (PRDUC) course - designed by the three institutions and conducted in collaboration with partner institutes in Africa and Asia. The chapter focuses in particular on the course conducted in 2004, which concentrated on issues surrounding ARV adherence. In line with the previous courses, it included the combination of public health, anthropological and health systems perspectives that characterizes the PRDUC course. The chapter also describes how the subsequent operational ART adherence studies - the results of which are presented and discussed in this publication - evolved, from proposal design through to the reporting of findings.
Through this process, we demonstrate that the combination of (i) a synthesis of perspectives; (ii) ongoing training and support; and (iii) strong commitment from both country-based researchers and international technical advisers, can produce comprehensive results that are fully 'owned' by the participating countries. This in turn means that study recommendations are more likely to be incorporated into national policies and guidelines, and subsequently implemented.