Does appreciative inquiry decrease false positive diagnosis during leprosy case detection campaigns in Bihar, India? An operational research study

Abstract

BackgroundIndia contributes ~60% to the global leprosy burden. The country implements 14-day community-based leprosy case detection campaigns (LCDC) periodically in all high endemic states. Paramedical staff screen the population and medical officers of primary health centres (PHCs) diagnose and treat leprosy cases. Several new cases were detected during the two LCDCs held in September-2016 and February-2018. Following these LCDCs, a validation exercise was conducted in 8 Primary health centres (PHCs) of 4 districts in Bihar State by an independent expert group, to assess the correctness of case diagnosis. Just before the February 2018 LCDC campaign, we conducted an “appreciative inquiry” (AI) involving the health care staff of these 8 PHCs using the 4-D framework (Discovery-Dream-Design-Destiny).ObjectivesTo assess whether the incorrect case diagnosis (false positive diagnosis) reduced as a result of AI in the 8 PHCs between the two LCDC conducted in September-2016 and February-2018.Methodology/principal findingsA three-phase quantitative-qualitative-quantitative mixed methods research (embedded design) with the two validation exercises conducted following September-2016 and February-2018 LCDCs as quantitative phases and AI as qualitative phase. In September-2016 LCDC, 303 new leprosy cases were detected, of which 196 cases were validated and 58 (29.6%) were false positive diagnosis. In February-2018 LCDC, 118 new leprosy cases were detected of which 96 cases were validated and 22 cases (23.4%) were false positive diagnosis. After adjusting for the age, gender, type of cases and individual PHCs fixed effects, the proportion of false positive diagnosis reduced by -9% [95% confidence intervals (95%CI): -20.2% to 1.7%, p = 0.068]ConclusionFalse positive diagnosis is a major issue during LCDCs. Though the decline in false positive diagnosis is not statistically significant, the findings are encouraging and indicates that appreciative inquiry can be used to address this deficiency in programme implementation.

Systematic review and narrative synthesis of the impact of Appreciative Inquiry in healthcare

“…A medium-quality study aimed to improve leprosy detection and false-positive rates. They saw a reduction in the false-positive rate of −9% (95% CI −20 to 1.3) 52. This suggests that there is no strong evidence to support Appreciative Inquiry being effective.…”

“…Of the eight studies reporting patient outcomes,8 9 18–21 29 35 49 50 52 four were high/medium-quality controlled studies8 9 18–21 and four were low-quality non-randomised studies 29 35 49 50…”

“…They saw a reduction in the false-positive rate of −9% (95% CI −20 to 1.3). 52 This suggests that there is no strong evidence to support Appreciative Inquiry being effective.…”

“…In terms of patient outcomes, there is some promising evidence for the use of Appreciative Inquiry from a study of infection control measures,8 9 although the study was underpowered, and from a leprosy study in India 52. The only other study on pain management in paediatrics looking at patient outcomes reported no change during the study 20 21.…”

Clinical and microbiological profile of Hansen’s diseases in a tertiary care centre of southwest Bihar

“…"They have reported from Bihar that false positive diagnosis is a major issue and decline in false positive diagnosis is not statistically significant." 9 Present study has been designed primarily to study the clinical presentation and microbiological profile of patients presenting with symptoms of Hansen disease and secondarily to know the smear positivity of patients with clinical manifestation of leprosy.…”