Abstract
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Objective: To explore behavioural factors relating to prescription adherence and the communication of prescription adherence messages for patients with acute febrile illness, and to develop a Training & Communication (T&C) intervention to be delivered as part of a clinical trial. The clinical trial intervention package consists of improved diagnostic tools, clinical practices and the T&C package, for children, adolescents and adults presenting with fever symptoms at outpatient facilities in five LMICs.; Design: Content analysis of primary, qualitative data collection, informed by the Capability, Opportunity, Motivation (COM-B) theory of behaviour, the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) approach.; Setting: Health facilities and local communities in five LMICs in Africa and Asia.; Participants: Health facility prescribers and local community adults.; Intervention: Febrile illness is a common presentation among adults and children in primary care settings, but diagnosing the cause of fever is challenging, especially in low-resource settings. Prescribers and patients behaviours underpin treatment practices, and antibiotics are the customary fallback choice for lack of better alternatives. However, in most cases antibiotics would not be required, do not cure the ongoing infection, and may have short-term (toxicity, costs) and long-term (drug resistance) untoward effects. ; Trialling new approaches including point-of-care tests and diagnostic algorithms alone would provide limited information on real-life applicability if behaviours are not accounted for. ; Accordingly, we designed an innovative, multiphase, mixed methods study, combining qualitative and behaviour approaches, with a quantitative two-arm, clinic based, randomised controlled trial. Qualitative and behavioural methods are used to: support the development of the Training & Communication component of the clinical trial, collect patient information on adherence, and support recommendations for future behaviour change interventions. ; This paper describes the qualitative research methods used to generate the clinical trial training and communication interventions, in support of adherence to prescriptions.