Can individuals’ beliefs help us understand nonadherence to malaria test results? Evidence from rural Kenya

Maffioli, Elisa M.; O’Meara, Wendy Prudhomme; Turner, Elizabeth L.; Mohanan, Manoj

doi:10.1111/rode.12708

Cited by 3 publications

(2 citation statements)

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“…In particular, we found that those who had higher confidence in RDT testing were more likely to adhere to a negative test result. We did not find that confidence in testing affected whether an individual got tested, similar to a previous study [ 38 ]. However, as in that study, the bar to testing was very low for participants: the RDT was free, a member of the study team would come and test at the household, and participants could get a free ACT if they tested positive for malaria.…”

Section: Discussionsupporting

confidence: 91%

“…These results suggest that people learn from their experience with testing and treatment. Our results are consistent with findings from population-level studies that show that greater access to testing increases people’s confidence in malaria testing [ 38 ] and can reduce inappropriate use of ACTs [ 22 , 39 ]. Unlike a previous study [ 40 ] however, we did not find any statistically significant effects of testing experience on confidence in AL, perhaps because confidence in AL was higher compared to confidence in RDTs, and adherence to a positive RDT was close to 100%, thus limiting the scope for learning about AL effectiveness.…”

Section: Discussionsupporting

confidence: 90%

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Experience and confidence in health technologies: evidence from malaria testing and treatment in Western Kenya

et al. 2022

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Background Low adoption of effective health technologies increases illness morbidity and mortality worldwide. In the case of malaria, effective tools such as malaria rapid diagnostic tests (RDTs) and artemisinin-combination therapies (ACTs) are both under-used and used inappropriately. Individuals’ confidence in RDTs and ACTs likely affects the uptake of these tools. Methods In a cohort of 36 households (280 individuals) in Western Kenya observed for 30 months starting in June 2017, we examined if experience with RDTs and ACTs changes people’s beliefs about these technologies and how those beliefs affect treatment behavior. Household members requested a free RDT from the study team any time they suspected a malaria illness, and positive RDT results were treated with a free ACT. We conducted annual, monthly, and sick visit surveys to elicit beliefs about the accuracy of malaria RDT results and the effectiveness of ACTs. Beliefs were elicited on a 5-point Likert scale from “very unlikely” to “very likely.” Results Over the study period, the percentage of survey respondents that said a hypothetical negative RDT result was “very likely” to be correct increased from approximately 55% to 75%. Controlling for initial beliefs, people who had been tested at least once with an RDT in the past year had 3.6 times higher odds (95% CI [1 1.718 7.679], P = 0.001) of saying a negative RDT was “very likely” to be correct. Confidence in testing was associated with treatment behavior: those who believed a negative RDT was “very likely” to be correct had 1.78 times higher odds (95% CI [1.079 2.934], P = 0.024) of adhering to a negative RDT result (by not taking ACTs) than those who were less certain about the accuracy of negative RDTs. Adherence to a negative test also affected subsequent beliefs: controlling for prior beliefs, those who had adhered to their previous test result had approximately twice the odds (OR = 2.19, 95% CI [1.661 2.904], P < 0.001) of saying that a hypothetical negative RDT was “very likely” to be correct compared to those who had not adhered. Conclusions Our results suggest that greater experience with RDTs can not only increase people’s confidence in their accuracy but also improve adherence to the test result.

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Section: Discussionsupporting

confidence: 91%