Page 162 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 7 of 14 Original Research

basis enhances a close association with each other that they Trust
are now a family. This is what a patient said about bonding: One of the counsellors explained the unspoken code of
‘Okay, you see here as we are at this club, we are a family now. conduct or the psychological contract, which exists among
We did not know each other, but now, as we are here, we know the members of the adherence club and the counsellors.
each other … This is my family. Some other people here, they do That is, club members and counsellors are not meant to
have families, but they do not tell their families that they have disclose the status of patients outside the adherence club
this.’ (Patient 2, female)
meeting or with a non-club member. One of the counsellors
explained how the underlying code of conduct to maintain
Perceived social support
confidentiality in the adherence clubs promotes trust among
Perceived social support speaks to the awareness of the the members:
positive impact that the moral, psychological or physical
support has on the patients receiving care in the adherence ‘They know that whatever happens here [in the club], it remains
club intervention. The nature of the support received here. We do not go and share things that are discussed here in
in the adherence club is predominantly peer support. the community. For example, if one of the club members is a
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According to Lee and Lok, peers can provide companionship, friend or a neighbour or whoever, maybe they go to church
stimulation, physical support, ego support and intimacy. together. They know that they are not allowed to go and talk
One of the patients indicated the nature of support that he or “that we are in the same club”. So, they know that one of the
she receives when they are in the adherence club re moral rules is like confidentiality. Whatever happens here, remains
here.’ (Counsellor 2, female)
support through chatting with other club members:
‘When I am here [in the club], I feel de-stressed (relaxed) like I am Perceived barriers
staying at home. I think the club is the right thing, because we
share some talks, “how is the medication you take?” I prefer the Perceived barriers to leave the club are related to the
club than to talk with friends.’ (Patient 1, male) circumstances that cause patients to be aware of the advantages
offered by the adherence club intervention in light of the
Knowledge acquisition challenges they face in regular clinic care. In the excerpt that
Knowledge acquisition is an important cognitive mechanism follows, a lay counsellor explained how perceived barriers
related to the health talks that are provided by the club related to seeking permission from work to pick up their
facilitators during each club meeting session. We found monthly ART from the healthcare facility. Patients in ART
that the acquisition of knowledge by the patients improves care, therefore, cherish the two monthly medication pickup
their self-efficacy – the perception of their ability to perform and the quick services offered at the club (nullifying the need
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activities related to the self-management of their disease. In for asking for permission):
the quote below, a patient explained some of the things that ‘When you are in the care of the facility, you only get maybe
they learn during the adherence club sessions, some related one month [medication supply]. So, every time you have to ask
to enhancing medication adherence and others with regard for a day off, leave, or something for you to get your
to preventing the spread of HIV: medication. So [in the club], it is much easier. It saves time and
‘In the club, they are open; they always tell us how to take the then you do not have to sit in the clinic for the whole day.’
tablets, what you are supposed to do. Like now, they were (Counsellor 1, female)
telling us that if you have a partner, you must not sleep without
a condom. You must always “condomise”. They were telling us The following excerpts outline aspects of the regular ART
about TB [Tuberculosis], the side effects of drinking alcohol clinic that patients perceive as barriers to their ART care.
whilst you are on medication and the side effects of smoking Because the adherence club is meant to remove these
cigarettes.’ (Patient 3, female)
barriers, it encourages them to remain in ART care under
One of the respondents suggested how this education the clubs:
received by the patients translates into understanding: ‘And waiting at the aisles is not so nice like here [in the clubs],
because then you have to wait for the doctors and you have to
‘When they receive the health talks, at least they will have a clear
understanding of what to do and how the club will be benefitting wait for everything, your tablets, even to go to the Pharmacy, but
them.’ (Counsellor 3, female) here [in the clubs], you can just come and get your medication
and weight and that is it.’ (Patient 4, male)
Based on our observation of the club sessions, we noticed
that the club facilitators also spent some time to remind the A patient also identified the potential of being stigmatised,
patients during the health talk of the rules and regulations which is part of the environment of the regular ART clinics as
guiding the adherence club. They emphasised the behaviours a perceived barrier. This barrier is minimal or absent in the
that could potentially lead to the patient being ousted from adherence club:
the club, indicating that the rules were being reinforced. One ‘Therefore, I have to stay stable, because we do not like to stand
of the counsellors confirmed this observation: there in front [in the regular clinic] so that the people are going to
‘Yes, the health talks have a very big impact, because it reminds judge us. So, I have to take my medication so that the people do
them [patients] of the dos and don’ts because if we do not give not see me there [in the regular clinic]. I must stay here at the club.’
the talks, patients will forget the rules.’ (Counsellor 1, female) (Patient 5, female)

http://www.sajhivmed.org.za 155 Open Access