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Table 2 Adherence barriers and strategies adopted

From: The integration of the treatment for common mental disorders in primary care: experiences of health care providers in the MANAS trial in Goa, India

Barriers to adherence Strategies
Inability to send reminders: due to wrong address or wrong phone number; no phone number; not giving consent to send reminder letter. *Reminders through a variety of modes tailored to each patient, for example: contact through community health workers, phone number of relatives or neighbors.
Cost: Medicines, Doctor's fee (GP practices), and travel for sessions. Addressing financial difficulties, for example providing information about widow pension or senior citizen welfare schemes.
Reducing costs, by prescribing cheaper ADT brands, providing free medication to patients with financial difficulties, long duration prescriptions.
Unable to come to the clinic: due to living long distance from clinic; child care responsibilities; unable to get time off work. Flexible appointments according to the convenience of the patient.
Reducing patient waiting time: registering in advance for doctor's appointment to avoid waiting in queue.
Age: Elderly patients forget appointment and also need company to come to clinic. Phone Counseling.
Seeking family support for example, to collect medication after the phone session with the patient.
Treatment related: "felt better" and thus discontinued treatment; side effects of medicine; no improvement with medication; long duration of treatment; no health care answers for life stressors. Addressing treatment concerns for example, joint consultation on side effects with the doctor.
Lack of engagement of treating doctor and/or clinic staff. *Regular feedback to doctor and primary care team about program performance.
Unavailability of ADT in local pharmacy. Checking and promoting the availability of ADT in local pharmacy.
  1. Note: * Strategies used in all cases