Indigenous Ancestral Spirit Possession Attribution and Antipsychotic Adherence in Ugandan Baganda Households: A Vignette-Based Discrete Choice Estimation of Family Accommodation and Medication Persistence
Namukasa Nalwoga Kirabo, Kizza Mbalire Ssentongo, Nabirye Namutebi Kigozi
Zenodo (CERN European Organization for Nuclear Research) October 22, 2026 preprint DOI: 10.5281/zenodo.23549769 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper |
|---|---|
| Key points | Proposes a formal framework in which ancestral spirit possession attribution shifts the marginal utility of biomedical antipsychotic treatment relative to ritual accommodation, replacing caregiver non-compliance assumptions with a model of resource substitution under competing therapeutic logics. The authors derive testable propositions about adherence under varying etiological certainty and household resource constraint, and propose a vignette-based discrete choice instrument to estimate family accommodation and medication persistence parameters. |
Abstract
Antipsychotic non-adherence in Ugandan Baganda households is frequently attributed to ancestral spirit possession, yet the behavioural pathway linking possession attribution to medication persistence remains unmodelled. The framework specifies how possession attribution shifts the marginal utility of biomedical treatment relative to ritual accommodation, and derives testable propositions about adherence under varying levels of etiological certainty and household resource constraint. A vignette-based discrete choice instrument is proposed for estimation of family accommodation and medication persistence parameters, with identification resting on within-respondent variation across experimentally manipulated attribution and severity conditions. The contribution is a formal account of how indigenous etiological models enter household decision-making about antipsychotic adherence, replacing the assumption of caregiver non-compliance with a model of resource substitution under competing therapeutic logics. Implications for adherence interventions in Baganda households are considered, and boundary conditions for the framework are stated.