TABLE 4.
Quotations Illustrating the Range of Perceived Facilitators and Challenges for Adherence to Calcium Supplementation Across High and Low Adherers, Ethiopia (N=48)a
| Facilitators | Illustrative Quotations |
|---|---|
| Reminders |
I used the calendar … I post it on the wall and always when I see it, I remember to take my pills. —25-year-old woman, 4-event, very high adherence My husband goes to work during my pill-taking times, which helps me remember. I also associate taking pills with mealtimes. —22-year-old woman, 3-event, increased adherence |
| Value of prevention |
I often think, “If I die from some problem, what would happen to my children?” I took these pills as you told me to prevent such risks. —27-year-old woman, 3-event, high adherence Other people may say, “Why do I bother to take the pills if I am healthy?” Those who are sick are more concerned with taking pills, but I keep taking them to help my baby survive. —38-year-old woman, 3-event, very high adherence |
| No adverse effects and relief of symptoms |
Feeling healthy and comfortable helped me take [calcium]. If I were not happy in taking the pill, I couldn’t take it. I may avoid it even. —37-year-old woman, 3-event, very high adherence Before I started to take these pills I had stomach aches and back pain. Now I am free from these problems. I like these pills very much due to the benefits I received. —30-year-old woman, 2-event, high adherence |
| Self-efficacy | My brothers asked me whether [calcium] is for [HIV/AIDS]. I don’t want to fear what other people think. I will use it without fear; it is about my health, not others. —30-year-old woman, 3-event, high adherence |
| Travel strategies | I took out one [calcium] pill and covered it with clean paper to bring with me. To take one pill, I do not want to carry all the pills in the bottle. If I carry the bottle, people may see it … attracting their attention. —22-year-old woman, 4-event, very high adherence |
| Trust in government and health services |
I am taking the pills consistently. People talk about the pills fattening the fetus… or other unjustified ideas … but health workers and government give this service for our benefit. —20-year-old woman, 2-event, very high adherence Since the government does not give us anything which hurts us, taking these pills is not difficult. —30-year-old woman, 3-event, adherence decreases |
| Counseling and follow-up support |
Your advice has also greatly influenced me to take the pills because I am convinced about their importance and I was committed to take the pills myself. —20-year-old woman, 3-event, high adherence Had I not received your advice on how to take [calcium] I could have stopped taking it. And I would have thrown away [IFA] because of the severe heartburn. After your advice to take it right before sleeping, there is no problem for me. —30-year-old woman, 4-event, very high adherence |
| Challenges | Illustrative Quotations |
| Forgetting |
It was difficult to take [calcium] every day because we are busy with harvest these weeks and I forget to take them. —18-year-old woman, 3-event, high adherence Taking [calcium] in the morning is difficult—breakfast may even be delayed—because when I wake up I directly deal with work and may forget it. —38-year-old woman, 2-event, decreased adherence |
| Away from home during the day |
Taking [calcium] midday is difficult. I went to visit my parents. I left in the morning but failed to come back the same day. I did not take pills for two days. To overcome this, I have to take the pills with me. —24-year-old woman, 4-event, very low adherence Midday, most times I am not at home. I may visit family whose relative died, attend a wedding, or travel elsewhere. In the morning no one leaves without breakfast and in the evening it is a must to come home for dinner, but it is unsuitable to take pills at lunchtime. —26-year-old woman, 3-event, very high adherence |
| Stigma and community perceptions |
People do not know [calcium]. They say, “During our pregnancy we took [IFA] but we don’t know this one.” People may assume this pill is given for [HIV/AIDs]. This pill is difficult for me because I don’t think people’s presumption will change and I don’t know what to do. —25-year-old woman, 4-event, very low adherence Taking these pills is very difficult. People who have seen me taking pills for a long time may suspect I am taking [HIV/AIDs] drugs. I can convince he who dares to ask me, but he who doesn’t know me and doesn’t ask, I don’t have the chance to explain the reality. —37-year-old woman, 4-event, very high adherence |
| Side effects |
I didn’t take [calcium] for the last week. I frequently felt nauseous and abdominal discomfort so I stopped. I feel real discomfort in taking it. I don’t feel healthy. —25-year-old woman, 4-event, very low adherence When I take [calcium] I tend to vomit. It nauseates me. I drink a lot of water and then swallow it. Without water it would have all come back up. I really took this pill with great difficulty … I took only for the sake of its benefit. — 20-year-old woman, 3-event, high adherence |
| Lack of food |
Most of the time I can’t find food in the morning. If I find a little food, I have to give priority to my kids. I do not want to take [calcium] if I am unable to find at least one mouthful. You told me to take it if I am unable to find food, but I’m afraid of taking pills like that. —33-year-old woman, 4-event, decreased adherence I haven’t stopped taking the pills. Even though I couldn’t get adequate and quality food, I took it with whatever food was available. —24-year-old woman, 2-event, very high adherence |
| Illness | I was sick. I couldn’t eat and I even drank coffee with difficulty. Now I have my health back. I can eat and do my work well. This is why I remember to take the pills. —27-year-old woman, 4-event, increased adherence |
| Large baby |
People in our community say during pregnancy pills fatten the fetus. This was discouraging me, but I think its advantage outweighs the disadvantage and I decided to take the pills. —30-year-old woman, 2-event, very low adherence My worry is the pills may fatten the fetus and cause problems during delivery. People in our community said this… I think it is [calcium], because it has milk content, but people say [IFA] can also fatten the fetus… I was taking it expecting its benefit outweighs this problem. I was waiting for you to clarify the reality. —28-year-old woman, 4-event, very high adherence |
Abbreviation: IFA, iron–folic acid.
a
Participants categorized by mean adherence rate to assigned regimen: over one-third (20/48) were “very high” adherers (90%–100%), 9 were “high” adherers (75%–89%), 4 were “low” adherers (45%–74%), and 3 were “very low” adherers (<45%). Twelve women did not fit these categories due to substantial changes in adherence over time: for 7 women adherence was categorized as “increased” and for 5 women adherence “decreased.”