School of Public Health, College of Health Sciences, Moi University, P.O BOX 512-30100, Eldoret, Kenya.
Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya.
BMC Public Health. 2022 Sep 6;22(1):1689. doi: 10.1186/s12889-022-14102-y.
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.
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."
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.
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.
全球范围内，有效卫生技术的采用率较低导致疾病发病率和死亡率上升。在疟疾方面，快速诊断检测试剂（RDTs）和青蒿素类复方疗法（ACTs）等有效工具的使用率均较低且使用不当。个人对 RDT 和 ACT 的信心可能会影响这些工具的采用。
在 2017 年 6 月开始的为期 30 个月的观察中，我们对肯尼亚西部的 36 个家庭（280 人）进行了研究，考察了 RDT 和 ACT 的使用经验是否会改变人们对这些技术的看法，以及这些看法如何影响治疗行为。家庭中的成员在怀疑患有疟疾时随时可以向研究小组申请免费 RDT，RDT 检测阳性的患者则接受免费的 ACT 治疗。我们每年、每月和每次就诊时都会进行调查，以了解人们对疟疾 RDT 检测结果准确性和 ACT 有效性的看法。人们对这些看法的评价采用 5 分制（“极不可能”到“极有可能”）。
在研究期间，称假设的 RDT 阴性结果“极有可能”正确的调查受访者比例从约 55%上升至 75%。在控制初始信念的情况下，过去一年中至少接受过一次 RDT 检测的人表示 RDT 阴性结果“极有可能”正确的可能性增加了 3.6 倍（95%CI [1,1.718,7.679]，P=0.001）。对检测的信心与治疗行为相关：那些认为 RDT 阴性结果“极有可能”正确的人更有可能（95%CI [1.079,2.934]，P=0.024）遵循 RDT 阴性结果（即不使用 ACT），而那些对 RDT 检测结果的准确性不太确定的人则不太可能遵循。对阴性检测的遵循也会影响后续的信念：在控制初始信念的情况下，与未遵循测试结果的人相比，那些遵循之前测试结果的人表示假设的 RDT 阴性结果“极有可能”正确的可能性约增加了两倍（OR=2.19，95%CI [1.661,2.904]，P<0.001）。
我们的研究结果表明，更多的 RDT 使用经验不仅可以提高人们对其准确性的信心，还可以提高对检测结果的遵循程度。
