The development of effective behaviour change interventions to support the use of malaria rapid diagnostic tests by Tanzanian clinicians

Implementation Science

Hugh Reyburn⁵  Ane Haaland²  Hilda Mbakilwa³  John Kessy³  Fortunata Nasuwa³  Célia Ponzo¹  Judith Meta³  Clare IR Chandler⁴ 

[1] Nutrition and Reproductive Health Unit, Ministry of Health, PO Box 52, Mont Fleuri, Republic of Seychelles;Institute of Health and Society, University of Oslo, PO Box 1130, Blindern NO-0318 Oslo, Norway;Joint Malaria Programme, Kilimanjaro Christian Medical Centre, PO Box 2228, Moshi, Tanzania;Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK;Department of Disease Control and Vector Biology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 9HT, UK

关键词: Formative research;    Evidence-based research;    Behaviour change theory;    Clinical practice;    Prescribing behaviour;    Rapid diagnostic tests;    Malaria;    Complex intervention;   

Others  :  1146955
DOI  :  10.1186/1748-5908-9-83

 received in 2013-12-17, accepted in 2014-06-09,  发布年份 2014

【 摘 要 】

Background

Parasitological confirmation is now recommended for all cases of suspected malaria. The roll-out of rapid diagnostic tests (RDTs) is hoped to enable this goal in low resource settings through point of care testing. However, simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians, with malaria continuing to be overdiagnosed in many settings. We undertook to design an evidence-based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania, to be evaluated through the Targeting Artemisinin Combination Therapy (TACT) cluster randomised controlled trial.

Methods

We describe five steps in our intervention design: formative research, review of existing evidence and theory, a workshop to define the intervention approach and content and results of formative research, engagement with behaviour change theory and literature, detailed design of intervention materials and piloting and pretesting of intervention materials. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania.

Results

The formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction, but that health workers used various techniques to resolve this, including provision of antimalarial drugs for RDT-negative patients. Our reviews showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice. Our design process is presented, drawing from this collective evidence. We describe the final TACT intervention package (including interactive small group workshops, feedback text messages, motivational text messages and patient information leaflets and posters) in terms of its programme theory and implementation theory.

Conclusions

Our study suggests that evidence-based design of complex interventions is possible. The use of formative research to understand malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test materials and methods prior to implementation. The TACT interventions may be appropriate for other settings where clinicians face similar challenges with malaria diagnostics.

Trial registration

NCT01292707.

【 授权许可】

   
2014 Chandler et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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