Monitoring patient care through health facility exit interviews: an assessment of the Hawthorne effect in a trial of adherence to malaria treatment guidelines in Tanzania

BMC Infectious Diseases

Research Article

David Schellenberg¹  Hugh Reyburn¹  Baptiste Leurent²  Florida Muro³  Hilda Mbakilwa³ 

[1] Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;

关键词: Hawthorne effect;    Patient exit interview;    Observer effect;    Malaria;    Rapid diagnostic test;    Primary health care facilities;    Tanzania;   

DOI  :  10.1186/s12879-016-1362-0

 received in 2015-04-01, accepted in 2016-01-18,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundSurvey of patients exiting health facilities is a common way to assess consultation practices. It is, however, unclear to what extent health professionals may change their practices when they are aware of such interviews taking place, possibly paying more attention to following recommended practices. This so-called Hawthorne effect could have important consequences for interpreting research and programme monitoring, but has rarely been assessed.MethodsA three-arm cluster-randomised trial of interventions to improve adherence to guidelines for the use of anti-malarial drugs was conducted in Tanzania. Patient interviews were conducted outside health facilities on two randomly-selected days per week. Health workers also routinely documented consultations in their ledgers. The Hawthorne effect was investigated by comparing routine data according to whether exit interviews had been conducted on three key indicators of malaria care. Adjusted logistic mixed-effects models were used, taking into account the dependencies within health facilities and calendar days.ResultsRoutine data were collected on 19,579 consultations in 18 facilities. The odds of having a malaria rapid diagnostic test (RDT) result reported were 11 % higher on days when exit surveys were conducted (adjusted odds ratio 95 % CI: 0.98-1.26, p = 0.097), 17 % lower for prescribing an anti-malarial drug to patients with a negative RDT result (0.56-1.23, p = 0.343), and 27 % lower for prescribing an anti-malarial when no RDT result was reported (0.53-1.00, p = 0.052). The effect varied with time, with a U-shaped association over the study period (p < 0.001). We also observed a higher number of consultations recorded on days when exit-interviews were conducted (adjusted mean difference = 2.03, p < 0.001).ConclusionsAlthough modest, there was some suggestion of better practice by health professionals on days when exit interviews were conducted. Researchers should be aware of the potential Hawthorne effect, and take into account assessment methods when generalising findings to the ‘real word’ setting. This effect is, however, likely to be context dependent, and further controlled evaluation across different settings should be conducted.Trial registrationClinicalTrials.gov: NCT01292707. Registered on 29th January 2011.

【 授权许可】

CC BY   
© Leurent et al. 2016