Health Policy and Planning: Does improving appropriate use of malaria medicines change population beliefs?

7 March, 2020

Yes, it does, according to this new paper. Citation, abstract, key messages and comment from me below.

CITATION: Elisa M Maffioli, Manoj Mohanan, Indrani Saran, Wendy Prudhomme O’Meara

Does improving appropriate use of malaria medicines change population beliefs in testing and treatment? Evidence from a randomized controlled trial

Health Policy and Planning, https://doi.org/10.1093/heapol/czaa010 [restricted access]

Published: 04 March 2020

ABSTRACT

A major puzzle in malaria treatment remains the dual problem of underuse and overuse of malaria medications, which deplete scarce public resources used for subsidies and lead to drug resistance. One explanation is that health behaviour, especially in the context of incomplete information, could be driven by beliefs, pivotal to the success of health interventions. The objective of this study is to investigate how population beliefs change in response to an experimental intervention which was shown to improve access to rapid diagnostic testing (RDT) through community health workers (CHWs) and to increase appropriate use of anti-malaria medications. By collecting data on individuals’ beliefs on malaria testing and treatment 12 and 18 months after the experimental intervention started, we find that the intervention increases the belief that a negative test result is correct, and the belief that the first-line anti-malaria drugs (artemisinin-based combination therapies or ACTs) are effective. Using mediation analysis, we also explore some possible mechanisms through which the changes happen. We find that the experience and knowledge about RDT and experience with CHWs explain 62.4% of the relationship between the intervention and the belief that a negative test result is correct. Similarly, the targeted use of ACTs and taking the correct dose—in addition to experience with RDT—explain 96.8% of the relationship between the intervention and the belief that the ACT taken is effective. As beliefs are important determinants of economic behaviour and might guide individuals’ future decisions, understanding how they change after a health intervention has important implications for long-term changes in population behaviour.

KEY MESSAGES

- Little is known about the role and the evolution of beliefs in the context of malaria.

- We investigate how population beliefs change in response to an experimental intervention that improves access to testing and increases appropriate use of antimalarial medications.

- We find that intervention increases the belief that a negative test result is correct and the belief that the first-line antimalarial drugs are effective.

- Using mediation analysis, we explore the mechanisms and we confirm that the changes in beliefs are due to behaviour changes caused by the experimental intervention.

COMMENT (Neil PW): This is interesting not only because it has 'implications for long-term changes in population behaviour' but also because it suggests that improvements in health care, especially when they can be rationalised and understood, can have a positive impact on beliefs and healthcare-seeking behahaviour. Does anyone know of other studies that support this hypothesis?

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil AT hifa.org