How Do Patients and Health Workers Interact around Malaria Rapid Diagnostic Testing, and How Are the Tests Experienced by Patients in Practice? A Qualitative Study in Western Uganda

Abstract

BackgroundSuccessful scale-up in the use of malaria rapid diagnostic tests (RDTs) requires that patients accept testing and treatment based on RDT results and that healthcare providers treat according to test results. Patient-provider communication is a key component of quality care, and leads to improved patient satisfaction, higher adherence to treatment and better health outcomes. Voiced or perceived patient expectations are also known to influence treatment decision-making among healthcare providers. While there has been a growth in literature on provider practices around rapid testing for malaria, there has been little analysis of inter-personal communication around the testing process. We investigated how healthcare providers and patients interact and engage throughout the diagnostic and treatment process, and how the testing service is experienced by patients in practice.MethodsThis research was conducted alongside a larger study which explored determinants of provider treatment decision-making following negative RDT results in a rural district (Kibaale) in mid-western Uganda, ten months after RDT introduction. Fifty-five patients presenting with fever were observed during routine outpatient visits at 12 low-level public health facilities. Observation captured communication practices relating to test purpose, results, diagnosis and treatment. All observed patients or caregivers were immediately followed up with in-depth interview. Analysis followed the ‘framework’ approach. A summative approach was also used to analyse observation data.ResultsProviders failed to consistently communicate the reasons for carrying out the test, and particularly to RDT-negative patients, a diagnostic outcome or the meaning of test results, also leading to confusion over what the test can detect. Patients appeared to value testing, but were frustrated by the lack of communication on outcomes. RDT-negative patients were dissatisfied by the absence of information on an alternative diagnosis and expressed uncertainty around adequacy of proposed treatment.ConclusionsPoor provider communication practices around the testing process, as well as limited inter-personal exchange between providers and patients, impacted on patients’ perceptions of their proposed treatment. Patients have a right to health information and may be more likely to accept and adhere to treatment when they understand their diagnosis and treatment rationale in relation to their perceived health needs and visit expectations.

Management and Follow-up Practices of Children with Unclassified Fever in Rural Ethiopia: Experiences of Health Extension Workers and Caregivers

“…The communication between health providers and patients about the purpose and result of mRDTs has previously been found to be poor. 19,20 In addition, although since 2010 the recommendation has been that antimalarial medication should only be given when a case is confirmed positive, 21 health workers still experience mistrust in mRDTs and insecurities about managing febrile children with negative mRDT results, thus often resorting to the use of antimalarials even when unnecessary. [22][23][24][25] It has been described that showing the test result to patients can help increase patients' trust and that a lack of communication about the test can lead to a patient misinterpreting its result.…”

“…[22][23][24][25] It has been described that showing the test result to patients can help increase patients' trust and that a lack of communication about the test can lead to a patient misinterpreting its result. 20 Thus, particularly for negative malaria test results and low fever, where according to iCCM no medication should be given, clear communication to caregivers of sick children becomes important. This could potentially prevent caregivers from believing that the HEW did not provide proper care and sent them home "empty handed."…”

Factors Associated with Utilization of Health Services in Rural Area in Ferlo, Senegal

“…Often, the patient is the victim of anonymization of his or her condition [19]. Inadequate communication between the patient and his or her caregiver causes problems in the use of health services [20]. In Africa," relational" dysfunctions in health services have unfortunately been evidenced by numerous observations.…”

Behaviors and Patterns of Searching Care Among Fulani's Children Living in Rural Area, in a Context of Therapeutic Pluralism in the Ferlo, Senegal

“…Often, the patient is the victim of the anonymization of his condition [23]. Inadequate communication between patients and their caregivers causes problems in the use of health services [24]. In Africa, the "relational" dysfunctions in health services have unfortunately been attested by numerous observations.…”