Factors affecting compliance to hospital visit among clubfoot patients: A cross-sectional study from a tertiary referral clubfoot clinic in the developing country

Abstract

Purpose: Ensuring compliance to treatment protocol, especially regular visit to treating facility, is an important aspect of clubfoot management. However, the factors affecting compliance to follow-up schedule are myriad. Methods: A cross-sectional study was undertaken among caregivers of clubfoot patients from a tertiary referral clubfoot clinic in a developing country. Hospital records were reviewed to collect demographic data and subjects were classified as either “regular” or “irregular” if they missed ≤3 and >3 scheduled hospital visits, respectively. Various factors that could affect compliance such as family size, number of children, literacy of caregiver, occupation of breadwinner, and time taken to travel to hospital were studied. Caregivers were probed regarding the reason for their irregularity. Results: A total of 238 patients were included, of which 138 formed the “regular” group and the rest 100 formed the “irregular” group. Patients in the regular group were significantly younger (mean age 43.8 months) compared to the irregular group (59.8 months; p = 0.001). The mean follow-up period in the regular group was 28.1 months and in the irregular group was 33.8 months. On univariate analysis, age, duration of follow-up, and transport duration were found to be significant between the two groups. However, multivariate analysis revealed that female children with clubfoot are more likely to be irregular as compared to males (p = 0.038). Conclusion: In a developing country setting, higher age and being a female child are associated with irregularity to hospital visit protocol. At clubfoot clinics, identifying these children and counseling their caregivers might improve compliance.

The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review

“…Often these clinics are packed and cannot offer patients and their parents any accommodation, adding accommodation costs onto the burden of lost wages and travel costs. 36 Three of the quantitative and mixed-methods studies were able to confirm the findings of the qualitative studies and prove a strongly significant relationship between 1) living below the poverty line and relapse 49 ( p = <0.001), 2) lack of financial support and relapse 50 ( p = 0.002), 3) cost of transport higher than 1 USD and relapse 50 ( p = 0.009), 4) distance to the Ponseti clinic of more than 9 km 50 ( p = 0.005) and non-compliance and 5) travel time to the Ponseti clinic between 6 and 12 h 51 ( p = 0.074) and drop-out.…”

“…Educational level of the parents – Educational level as a risk factor was identified in one qualitative study 37 and in one mixed-methods study, however the risk factor's impact was not statistically significant ( p = 0.191) . 51 Several qualitative studies, however, looked beyond the strict definition of educational level and were able to link lack of knowledge about the Ponseti treatment 39 , 40 , 41 , 43 , 45 , 51 , 52 and lack of knowledge about clubfoot in general 35 to drop-out and non-compliance. Kazibwe et al.…”

“…only found a moderate non-significant relationship between drop-out and number of children in the household. 51 Four studies describe being a girl as a risk factor for accessing and continuing adequate care. In India, girls have 2.6 times increased risk of dropping out compared to boys, 51 and they are also at risk of not properly receiving full treatment until they are at a marriable age.…”

“…Reduced access to care for girls was identified as an important and statistically significant risk factor in two studies from South Asia and in one study from the Caribbean. 36 , 44 , 46 , 51 Women and girls are known to have reduced access to health care compared to their male counterparts around the world and especially when living in poverty. 54 Additionally, disabled women and girls lack access to adequate services around the globe and are at increased risk for discrimination and abuse.…”

Resource‐appropriate selection of osteosarcoma treatment protocols in low‐ and middle‐income countries

“…Social stigma to cancer is rampant 93 . Further, there may be gender bias in treatment, with neglect of female children, as evidenced in other diseases such as clubfoot 94 . Amputation is socially unacceptable among certain groups, even in this life‐threatening disease 95 .…”