RT Journal Article
SR Electronic
T1 When Knowledge Is Not Enough: Applying a Behavioral Design Approach to Improve Fever Case Management in Nigeria
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200211
DO 10.9745/GHSP-D-22-00211
VO 10
IS 6
A1 Haqqi, Faraz
A1 Acosta, Angela
A1 Sridharan, Sriram
A1 Zimmerman, Emily
A1 Ogunbi, Temitope
A1 Idiong, Eno’bong
A1 Inyang, Uwem
A1 Oyedokun-Adebagbo, Foyeke
A1 Tchofa, Jose
A1 Diallo, Nene
A1 Mtiro, Emma
A1 Okoronkwo, Chukwu
A1 Aiyenigba, Bolatito
YR 2022
UL http://www.ghspjournal.org/content/10/6/e2200211.abstract
AB Key FindingsHealth care providers encounter various behavioral barriers when trying to follow case management guidelines—even those providers who are aware of proper case management protocols and intend to follow them.Understanding that behavioral drivers varied between individuals allowed for the design of a multipronged intervention to address the combination of factors influencing provider behavior.The intervention streamlined processes for overburdened providers, allowing them to focus their attention and efforts where they are most impactful.In addition to correcting provider misconceptions, the solutions also created a shared understanding of the reliability of malaria rapid diagnostic tests among providers and reset expectations with respect to patient case management and facility-wide adherence to national guidelines.Key ImplicationIn challenging environments, a behavioral design approach can help improve case management practices by focusing solutions on removing barriers to create an environment more conducive to all of the tasks that case management requires, equipping providers with tools to better navigate the barriers they encounter, and establishing workplace norms to support and sustain changes in provider behavior.Background:We sought to encourage health care providers to adhere to national malaria case management guidelines. This requires them to conduct malaria parasite tests for every patient presenting with a fever and provide malaria treatment only to those who test positive for malaria. Our goal was to make it easier for providers to follow guidelines by addressing drivers of nonadherence uncovered through facility observations and interviews with staff and clients.Implementation and Monitoring:The case management interventions were piloted in 12 public health facilities in Akwa Ibom, Kebbi, and Nasarawa states in Nigeria between October and December 2019. Participating facilities included 1 hospital and 3 primary health centers in each state. Relevant changes included the following: (1) providers at each facility participated in facilitated discussions to correct misconceptions about the reliability of malaria test kits; (2) testing procedures were integrated into existing triage systems; (3) treatment algorithms were integrated into medical record forms; (4) providers were issued pictorial brochures outlining danger signs to share with clients, together with instructions for when to seek further care; and (5) a process was created for facilities to monitor their own adherence to guidelines.Lessons Learned:The lessons learned include: (1) disentangling the drivers of behavior allows for more targeted solutions, (2) solutions that streamline processes for overburdened providers allow them to redirect their attention and efforts where they can be most impactful, and (3) changing staff perceptions of workplace norms can support a holistic and sustained approach to behavior change.