Why do individuals comply with mass drug administration for lymphatic filariasis? A case study from Alor District, Indonesia

Lymphatic filariasis (LF) is a parasitic disease affecting more than 120 million people; over a billion persons live at risk for infection. Filariasis does not kill, but rather disables; making it an important public health -and socio-economic issue facing developing' countries. In 1998, the Global Programme to Eliminate LF (GPELF) was created to eliminate LF by 2020 using mass drug administration (MDA) requiring the entire eligible population living in endemic areas to take treatment once a year for 4-6 years. Challenges to elimination include: (I) convincing asymptomatic persons to comply; (2) maintaining high levels of compliance; (3) managing adverse reactions. Research on compliance has focused on associated factors rather than on influences. GPELF recognises the relevance of this information to its success and has called for increased research on individual motivations. This study aims to make an original contribution to existing research by describing the reasons people comply with treatment within the context of Alor District. By using theoretical perspectives from social dilemma theory and health promotion theories, the research examines how various elements may influence a person to cooperate and consume LF treatment. Research methods include a preliminary quantitative survey (2004) (n=336) and in depth interviews (2005) (n=43) with compliers and non-compliers in Alor District, Indonesia. Analysis of results shows non-health related factors are the strongest reported influences on compliance; namely emotions, coercion, power, hierarchy and norms. Lay beliefs about disease reveal complex interpretations which do not necessarily predict compliance. The research demonstrates the complexities of interventions in societies undergoing transition from traditionally-based towards increased development. Research recommendations include re-evaluating present theoretical reasoning behind GPELF-recommended social mobilisation to include group interaction and cooperation, which have shown to be more appropriate in encouraging compliance. Furthermore, this research recommends wider use and promotion of non-health related benefits to LF treatment.