Repeat Interviews Research Articles

Financial Inclusion or Encampment? Rethinking Digital Finance for Refugees

Humanitarian actors touting financial inclusion posit that access to financial services builds refugees’ resilience and self-reliance. They claim that new digital financial tools create more efficient and dignified pathways for humanitarian assistance and enable refugees to better manage their savings and invest in livelihoods, especially during protracted displacement. Our in-depth, repeat interviews with refugees in Kenya and Jordan refute this narrative. Instead, self-reliance was hindered primarily by refugees’ lack of foundational rights to move and work. Financial services had limited ability to support livelihoods in the absence of those rights. The digital financial services offered to refugees under the banner of ‘financial inclusion’ were not mainstream services designed to empower and connect. Instead, they were segregated, second-class offerings meant to further isolate and limit refugee transactions in line with broader political desires to encamp and exclude them. The article raises questions about the circumstances in which humanitarian funding ought to fund financial service interventions and what those interventions are capable of achieving.

Future public health emergencies and disasters: sustainability and insights into support programs for healthcare providers

BackgroundThe mental health of healthcare workers (HCWs) has been at the forefront throughout the COVID-19 pandemic. While workplace-based support programs have been developed in hospitals globally, few systematically collected data. While critical to their success, information on these programs and the experience of mental healthcare providers (MHP) who support colleagues is limited. The objective of this study was to explore the experiences of MHP caring for HCW colleagues within a novel workplace-based mental health support program during the COVID-19 pandemic, to provide insights on facilitators, areas for improvement and barriers to program sustainability.MethodsThis qualitative study used semi-structured interviews conducted by videoconference between September 2020 to October 2021. UHN CARES (University Health Network Coping and Resilience for Employees and Staff) Program was developed during the first wave of the COVID-19 pandemic in March 2020. It supports over 21,000 staff members within the UHN, Canada’s largest academic health research institution, in Toronto, Canada. Purposive sampling was used to select 10 of the 22 MHP in the UHN CARES Program (n = 10). Using a critical realism framework, key components required to sustain a successful workplace-based mental health support program for HCWs and balance the needs of MHP were determined.ResultsSix psychiatrists and four psychologists (n = 10) with varying roles at UHN participated in 17 interviews, including seven repeat interviews exploring changes over time within the pandemic and program. Components which facilitated the success of the program included flexibility in scheduling, confidential health record storage, comprehensive administrative support, availability of resources and adaptive quality improvement approach. Recommendations for improvement included opportunities for peer supervision, triaging of cases, and managing HCW expectations. MHP found caring for HCWs to be meaningful and they utilized existing clinical skills during sessions. Challenges included working in a virtual setting, navigating boundaries when caring for colleagues, and managing the range of service users and their needs.ConclusionsThese findings suggest how support programs can be structured for HCWs, how to provide support, and how to sustain this support, allowing health systems to balance the needs of HCWs and MHPs in preparation for future public health emergencies.

Time and mobility/immobility: the chronopolitics of mobility and the temporalities of suffering and hope in situations of encampment

The article engages with the relationship between the chronopolitics of mobility and migrants’ narratives of the past, their present suffering, and hope for the future. Data collected through observation and repeat interviews with migrants in the Moria and Kara Tepe camps in Lesvos, Greece, challenge the assumption that ‘time’ spent waiting in the camps by illegalized migrants represents a linear and singular metanarrative of the migrant in ‘temporal suspension’ from the ‘grid of modernity’. I suggest, that the concept of historical time allows for a critical analysis of illegalized migrants’ narratives of their past lives, their present suffering and future aspirations, through which they challenge the chronopolitics of control inherent in the current EU migration system. While such narratives might at first sight be understood as accepting a migration system based on suspension and gradual re-introduction into western historical and political time, they present a challenge to the exceptionality of western modernity and their suspension from it. I also argue, that narratives of ‘pasts’, ‘the present’ and hope for the ‘future’, challenge academic discourses of migration that centre on the notion of ‘bare life’, where historical and political time is suspended in the liminal space of the camp.

Strong structuration analysis of patterns of adherence to hypertension medication

Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines, especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities, identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent, consistently non-adherent, and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent, 9 consistently non-adherent, 9 increasingly adherent, and 4 increasingly non-adherent. For the consistently adherent, positive views about prescribed medication and family support encouraged adherence. Conversely, negative views of medication and lack of family support were notable amongst the consistently non-adherent, along with resistance to accepting a ‘sick’ label. A shift toward positive views of medication was detected amongst those whose adherence improved, along with worsening health and increased family support. A decrease in financial resources drove some participants to become less adherent, especially if they already held negative views toward medication. This study sheds light on the variety of medication adherence patterns among poor people with hypertension in the Philippines, as well as the complex web of elements influencing their treatment choices. The results point to the potential for measures that address concerns about medicines and increase family support.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

Student Subjectivity in the Marketised University.

We present data from an exploratory qualitative interview-based pedagogical research project on the development of student agency in higher education. Our aim was to respond to Nick Zepke’s claim that what is often missing from the current neoliberal discourse of higher education ‘is students having a voice in what and how they learn and how they can action their voice in the wider community as agentic citizens.’ Informed by Lacanian discourse analysis, our project investigated the opportunities and threats facing some of our undergraduate students as they struggled to exercise agency and develop autonomy in the marketised university. Repeat interviews (n = 15) with final year students focussed on the psychosocial categories of power, affect, intersubjectivity and desire. The analysis was guided by Lacan’s theory of the four discourses, an account of the vicissitudes of agency. We found that students can move between discourses depending on the extent to which their agency (operationalised here as Lacan’s ‘object cause of desire,’ the objet petit a) was enabled or thwarted. Our critique of the metaphor of the ‘student journey’ addresses the implications for learning and teaching and the university’s mission to develop its students in light of perceived commercial pressures.

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment.

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of ‘mazing’ (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.

COVID-19 Vaccines in Skilled Nursing Facilities: Recurring Interviews with Administrators

Skilled nursing facilities (SNFs) are on the front lines of changing policies regarding the COVID-19 pandemic. The most recent development is a potential vaccine mandate for staff working in SNFs. We use ongoing findings from 130 of 160 in-depth, semi-structured interviews in progress with administrators at 40 SNFs in eight diverse healthcare markets across the United States to understand the current landscape of COVID-19 in SNFs. Four repeated interviews at 3-month intervals provide a unique longitudinal perspective on the impact of COVID-19 and SNFs’ response to vaccinations, including the vaccine mandate. Rigorous thematic analysis reveals insights into administrator responses and creative approaches to address vaccine hesitancy, and future expectations for SNF operations in light of the vaccine and the mandate. Administrators express cautious hope that the vaccine will allow SNFs to return to a new normal of daily life for residents in terms of family visitations, communal dining, and resident activities. Overriding questions include how to overcome persistent vaccine hesitancy from SNF staff who cite fear of side effects despite education initiatives and how to stem staff retirement or transition to other healthcare settings. SNFs represent a microcosm of the country’s concerns as a whole. Insight into the evolving and complex dynamics shed important light on national trends and help provide solutions for moving forward. Findings from this study have implications for policymakers and SNF leadership as they consider ways to promote vaccination and retain staff amid vaccine mandates.

Ethnobotanical study of plants used by the Munda ethnic group living around the Sundarbans, the world's largest mangrove forest in southwestern Bangladesh

Ethnopharmacological relevanceIndigenous knowledge of medicinal plants is an integral part of the primary health care (PHC) system in almost every society. For more than two centuries, Munda, a small ethnic group in Bangladesh, has lived around the Sundarbans, the world's largest mangrove forest. This mangrove is rich in biodiversity but is threatened by global climate change. Information on the therapeutic use of plants by Munda ethnic minorities remains completely unknown. Therefore, it needs urgent documentation. Aim of the studyThe purpose of the study is (1) to search and compile data on the diversity of medicinal plants used by the Munda people for PHC needs, and (2) Quantitative analysis of these data to identify important medicinal plants and diseases related to treatment by this species. Material and methodsWe conducted repeated field surveys and interviews among 79 Munda informants to collect ethnobotanical data. Informants were selected through random sampling techniques and interviewed using an open and semi-structured questionnaire. We reported the primary (absolute) data as use reports (URs) with frequency citation (FC). The International Classification of Primary Care-2 (ICPC-2) was followed to categorize the therapeutic use of medicinal plants, and quantitative analysis was performed using the FC and informant consensus factor (ICF). ResultsThe present study explored and compiled a total of 3199 medicinal URs for 98 medicinal plant species to treat 132 ailment conditions under sixteen (16) ICPC-2 pathological groups. The highest URs (948) were noted for the digestive (D) group treated by 69 plant species, where the highest ICF value was measured for the social problem (Z) disease category (ICF: 1.00). Of the recorded medicinal plants, 17 were identified as true Mangrove (MNG), 24 as Mangrove Associates (MNA), and 57 as Non-Mangrove (NMG) species. Fabaceae (13 species) represented the leading family, followed by Lamiaceae and Compositae (5 species). Herbs (43%) have shown dominant life forms, and the leaves (41%) were frequently used plant parts. The most commonly cited preparation method was juice (24%), and the prevalent mode of administration was oral (62%). Azadirachta indica A. Juss. was the most widely used therapeutic plant species based on FC (39) values. The comparative literature review study reveals that the practices of 15 plants and their ethnomedicinal use by the Munda people are still entirely unexplored and newly reported in Bangladesh. Additionally, therapeutic use of 2 species, Brownlowia tersa (L.) Kosterm., and Dalbergia candenatensis (Dennst.) Prain has not been previously reported worldwide. In addition, 51 plant species (52%) of the total plants studied enlisted on the IUCN Red List of Threatened Species. ConclusionTo our knowledge, this is the first ethnobotanical study on the Munda ethnic group in Bangladesh. This study indicates that Munda people still rely on medicinal plants for PHC and have a rich and varied traditional knowledge about the therapeutic use of plants. This study also warns of the high risk of the current availability status of plants in the study area. Therefore, this study calls for urgent steps to protect and conserve high-risk plants that can be done by taking both in-situ and ex-situ measures. In addition, further phytochemical and pharmacological investigations of the important medicinal plants cited in the study have been suggested.

(De)constructing ‘therapeutic itineraries’ of hypertension care: A qualitative study in the Philippines

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the ‘therapeutic itineraries’ of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as ‘pre-diagnosis’ (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.

What has become of the Indignados? The biographical consequences of participation in the 15M movement in Madrid (2011–19)

ABSTRACT This article examines the biographical consequences of participation in 15 M by following the trajectories, from May 2011 to November 2019, of individuals who took part in the movement in Madrid. Based on a field study combining observations and repeat interviews, this follow-up of the trajectories of forty Indignados (22 in the period 2013–15 and 18 to 2019) reveals considerable biographical impacts on both representations and individual practices in the political, personal and professional spheres. These impacts were particularly salient among those who had experienced biographical disruptions, whether in relation to political socialization or a drop in social status, and those who had mobilized in an intense and lasting way. However, 15 M had also had a profound influence on the biographies of those with an activist background and those who had been less involved in the movement. This microsociological approach gives us a better understanding of the biographical trajectories of the Indignados and provides an account of the transformations in collective action in Madrid over the past ten years. The main legacy of 15 M is therefore that it created a new generation of activists who are now involved in a multitude of activist microspheres and institutional settings.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway.

BackgroundGirls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services.MethodsWe conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need.FindingsWe identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers.ConclusionAssessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.

Doing gender and being gendered through occupation: Transgender and non-binary experiences

Background Transgender people can face discrimination which can be reflected in and encoded by their occupational experiences. There is emerging research regarding those who are transgender but experiences of non-binary people remain under-explored. Purpose This study considered the occupational experiences of transgender and non-binary people and how gender expression related to engagement in occupations and space. Method Five transgender and non-binary people participated in repeat interviews, including a ‘walking interview’. Analysis was informed by new materialism. Findings Occupational engagement can re-enforce binary understandings of gender or facilitate creative expressions of gender identity. Within normative environments, occupational participation can offer assimilation, particularly for non-binary people. Some occupations provided emancipation from binary gender norms through expression such as clothing and creative activities which provided recognition and belonging. Symbolic and personal meanings of occupations shifted when participants were able to express themselves in a way that felt authentic. Conclusion ‘Occupational assimilation’ can bring safety from scrutiny for those who are transgender and non-binary but curtails authentic expression. Occupational therapists have a role in supporting transgender and non-binary people in accessing occupations which facilitate their authentic gender expression and need to improve critical awareness of the culturally encoded binary nature of many occupations and environments.

Trading Fast and Slow: Fish Marketing Networks Provide Flexible Livelihood Opportunities on an East African Floodplain

Domestic marketing networks in inland small-scale fisheries (SSF) provide food and income to millions of the rural poor globally. Yet these contributions remain undervalued, as most trade is informal and unmonitored, and inland fisheries overlooked in research and policy. Taking a commodity chain approach, we provide a case study of access arrangements governing how people come to enter and benefit from the freshwater fish trade on Tanzania's Rufiji River floodplain. We conducted a repeat market survey, interviews, and participant observation with actors at all levels of the district trade over 15 months. Gender, age, and social capital structured participation patterns, with younger men dominating the more lucrative but riskier fresh trade, older men prioritizing steady income from smoked fish, and women culturally constrained to selling a “cooked” product (i.e., fried fish). Nearly all participants were local, with traders drawing on a complex web of relationships to secure supplies. The majority of market vendors cited the trade as their household's most important income source, with women's earnings and consumption of unsold fish likely to have substantial benefits for children's well-being. Our findings reveal a resilient and pro-poor trade system where, starting with small initial investments, people overcame considerable environmental, financial, regulatory, and infrastructural challenges to reliably deliver fish to rural and urban consumers. Preserving the ecological integrity of Rufiji wetlands in the face of hydro-power development and climate change should be a priority to safeguard the livelihoods and well-being of local inhabitants.

Cellphones and romantic relationships of young women in urban informal settlements in South Africa

Cellphones have impacted on people’s intimate sexual relationships. Using the framework of relationship formation, maintenance and ending, we explore how cellphones and attendant social media have impacted on relationships among a group of young women living in urban informal settlements in Durban, South Africa. We conducted in-depth repeat interviews with 15 women enrolled in the Stepping Stones and Creating Futures trial, as well as group discussions and light-touch participant observation. Our data show that cellphones and social media are central to women’s sexual relationships and allow women greater control over relationships – particularly their formation. However, cellphones and social media also enable greater control and monitoring by partners. In this study, cellphones were central in establishing (or not) trust in relationships, as well as being gifts, sometimes given by men to demonstrate love, but often becoming a snare for women who then struggled to end relationships because the phones ‘remained’ the property of the man. We conclude that while cellphones have created new spaces and opportunities for women’s agency, overall the wider social and material forces of women’s existence were deeply constraining and were the main driver of patterns in women’s relationships.

Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention.

Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.

Using the \u2018good farmer\u2019 concept to explore agricultural attitudes to the provision of public goods. A case study of participants in an English agri-environment scheme

Across the European Union, the receipt of agricultural subsidisation is increasingly being predicated on the delivery of public goods. In the English context, in particular, these changes can be seen in the redirection of money to the new Environmental Land Management scheme. Such shifts reflect the changed expectations that society is placing on agriculture—from something that provides one good (food) to something that supplies many (food, access to green spaces, healthy rural environment, flood resilience, reduced greenhouse gas emissions). Whilst the reasons behind the changes are well documented, understanding how these shifts are being experienced by the managers expected to deliver on these new expectations is less well understood. Bourdieu’s social theory and the good farmer concept are used to attend to this blind spot, and to provide timely insight as the country progresses along its public goods subsidy transition. Evidence from 65 interviews with 40 different interviewees (25 of whom gave a repeat interview) show a general willingness towards the transition to a public goods model of subsidisation. The optimisation and efficiency that has historically characterised the productivist identity is colouring the way managers are approaching the delivery of public goods. Ideas of land sparing and land sharing (and the farming preference for the former over the latter) are used to help understand these new social and attitudinal realities. The policy implications of these findings are discussed, with reference to the new scheme’s ‘priority themes’.

Validation of a new hemifacial spasm grading questionnaire (HFS score) assessing clinical and quality of life parameters

Validation of the new hemifacial spasm (HFS) questionnaire “HFS score” that captures both clinical (HFS clinical) and health-related quality of life (HRQOL) parameters (HFS subjective) in one tool and comparison with a global HRQOL questionnaire. Cross sectional, prospective validation study including 143 subjects (62 HFS patients and 81 healthy volunteers) from the University Eye Hospital Bonn. Patients were interviewed with the new HFS score and the SF-12 questionnaire prior to and 3 weeks after Botulinum neurotoxin A (BoNT-A) injection. All HRQOL-related questions (HFS subjective) were answered on a visual analogue scale (VAS) ranging from 0 (no complaints) to 100% (maximum complaints) by the patients themselves. Reproducibility was tested in a study extension with 10 patients by repeat interviews (telephone/personal). The new HFS score questionnaire provided a reliable clinical assessment and demonstrated that BoNT-A therapy significantly reduced frequency and severity of eye and cheek spasms (p < 0.001; Wilcoxon test). Relevant aspects of HRQOL of HFS patients were assessed with high accuracy and sensitivity. Significant improvements were achieved after BoNT-A injection in five out of eight HRQOL parameters (p ≤ 0.02; Wilcoxon test). Cronbach’s alpha of 0.818 demonstrated good internal consistency. Telephone survey provided comparable results to personal interviews. This new sensitive and specific HFS score seems a reliable instrument to monitor BoNT therapy and customize it to the needs of the individual HFS patient—in clinical studies and daily clinical practice.

Impact of COVID-19 on child malnutrition, obesity in women and household food insecurity in underserved urban settlements in Sri Lanka: a prospective follow-up study.

To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic. A prospective follow-up study. In 2019, the baseline Urban Health and Nutrition Study 2019 (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35 % of households from the UHNS-2019 cohort were randomly selected for repeat interviews, 1 year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer-administered questionnaires. Differences in measurements at baseline and follow-up studies were compared. A total of 207 households, comprising 127 women and 109 children were included. The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18·3 % v. 13·7 %; P = 0·26 and 8·3 % v. 3·7 %; P = 0·12, respectively). There was a decrease in prevalence of child stunting (14·7 % v. 11·9 %; P = 0·37). A change was not observed in overall obesity in women, which was about 30·7 %. Repeated lockdown was associated with a significant reduction in food security from 57 % in UHNS-2019 to 30 % in the current study (P < 0·001). There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

Interprofessional Medication Adherence Program for Patients With Diabetic Kidney Disease: Protocol for a Randomized Controlled and Qualitative Study (PANDIA-IRIS).

BackgroundDespite effective treatments, more than 30% of patients with diabetes will present with diabetic kidney disease (DKD) at some point. Patients with DKD are among the most complex as their care is multifactorial and involves different groups of health care providers. Suboptimal adherence to polypharmacy is frequent and contributes to poor outcomes. As self-management is one of the keys to clinical success, structured medication adherence programs are crucial. The PANDIA-IRIS (patients diabétiques et insuffisants rénaux: un programme interdisciplinaire de soutien à l’adhésion thérapeutique) study is based on a routine medication adherence program led by pharmacists.ObjectiveThe aim of this study is to define the impact of the duration of this medication adherence program on long-term adherence and clinical outcomes in patients with DKD.MethodsThis monocentric adherence program consists of short, repeated motivational interviews focused on patients’ medication behaviors combined with the use of electronic monitors containing patients’ medications. When patients open the electronic monitor cap to take their medication, the date and hour at each opening are registered. In total, 73 patients are randomized as 1:1 in 2 parallel groups; the adherence program will last 6 months in the first group versus 12 months in the second group. After the intervention phases, patients continue using their electronic monitors for a total of 24 months but without receiving feedback. Electronic monitors and pill counts are used to assess medication adherence. Persistence and implementation will be described using Kaplan-Meier curves and generalized estimating equation multimodeling, respectively. Longitudinal adherence will be presented as the product of persistence and implementation and modelized by generalized estimating equation multimodeling. The evolution of the ADVANCE (Action in Diabetes and Vascular disease: Preterax and Diamicron Modified-Release Controlled Evaluation) and UKPDS (United Kingdom Prospective Diabetes Study) clinical scores based on medication adherence will be analyzed with generalized estimating equation multimodeling. Patients’ satisfaction with this study will be assessed through qualitative interviews, which will be transcribed verbatim, coded, and analyzed for the main themes.ResultsThis study was approved by the local ethics committee (Vaud, Switzerland) in November 2015. Since then, 2 amendments to the protocol have been approved in June 2017 and October 2019. Patients’ recruitment began in April 2016 and ended in October 2020. This study was introduced to all consecutive eligible patients (n=275). Among them, 73 accepted to participate (26.5%) and 202 (73.5%) refused. Data collection is ongoing and data analysis is planned for 2022.ConclusionsThe PANDIA-IRIS study will provide crucial information about the impact of the medication adherence program on the adherence and clinical outcomes of patients with DKD. Monitoring medication adherence during the postintervention phase is innovative and will shed light on the duration of the intervention on medication adherence.Trial RegistrationClinicaltrials.gov NCT04190251_PANDIA IRIS; https://clinicaltrials.gov/ct2/show/NCT04190251International Registered Report Identifier (IRRID)DERR1-10.2196/25966