Indigenous Ancestral Spirit Possession Attribution and Antipsychotic Adherence in Ugandan Baganda Households: A Vignette-Based Discrete Choice Estimation of Family Accommodation and Medication Persistence

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.