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Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments

BACKGROUND: The currently recommended approach for preventing malaria in pregnancy (MiP), intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT), has been questioned due to the spread of resistance to SP. Whilst trials are underway to test the efficacy of future alternative appro...

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Autores principales: Lagarde, Mylene, Smith Paintain, Lucy, Antwi, Gifti, Jones, Caroline, Greenwood, Brian, Chandramohan, Daniel, Tagbor, Harry, Webster, Jayne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158799/
https://www.ncbi.nlm.nih.gov/pubmed/21886800
http://dx.doi.org/10.1371/journal.pone.0023588
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author Lagarde, Mylene
Smith Paintain, Lucy
Antwi, Gifti
Jones, Caroline
Greenwood, Brian
Chandramohan, Daniel
Tagbor, Harry
Webster, Jayne
author_facet Lagarde, Mylene
Smith Paintain, Lucy
Antwi, Gifti
Jones, Caroline
Greenwood, Brian
Chandramohan, Daniel
Tagbor, Harry
Webster, Jayne
author_sort Lagarde, Mylene
collection PubMed
description BACKGROUND: The currently recommended approach for preventing malaria in pregnancy (MiP), intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT), has been questioned due to the spread of resistance to SP. Whilst trials are underway to test the efficacy of future alternative approaches, it is important to start exploring the feasibility of their implementation. METHODS AND FINDINGS: This study uses a discrete choice experiment (DCE) method to assess the potential resistance of health workers to changing strategies for control of MiP. In Ashanti region in Ghana, 133 antenatal clinic health workers were presented with 16 choice sets of two alternative policy options, each consisting of a bundle of six attributes representing certain clinical guidelines for controlling MiP (type of approach and drug used), possible associated maternal and neo-natal outcomes, workload and financial incentives. The data were analysed using a random effects logit model. Overall, staff showed a preference for a curative approach with pregnant women tested for malaria parasites and treated only if positive, compared to a preventive approach (OR 1.6; p = 0.001). Increasing the incidence of low birth weight or severe anaemia by 1% would reduce the odds of preferring an approach by 18% and 10% respectively. Midwives were more resistant to potential changes to current guidelines than lower-level cadres. CONCLUSIONS: In Ashanti Region, resistance to change by antenatal clinic workers from a policy of SP-IPT to IST would generally be low, and it would disappear amongst midwives if health outcomes for the mother and baby were improved by the new strategy. DCEs are a promising approach to identifying factors that will increase the likelihood of effective implementation of new interventions immediately after their efficacy has been proven.
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spelling pubmed-31587992011-08-30 Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments Lagarde, Mylene Smith Paintain, Lucy Antwi, Gifti Jones, Caroline Greenwood, Brian Chandramohan, Daniel Tagbor, Harry Webster, Jayne PLoS One Research Article BACKGROUND: The currently recommended approach for preventing malaria in pregnancy (MiP), intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT), has been questioned due to the spread of resistance to SP. Whilst trials are underway to test the efficacy of future alternative approaches, it is important to start exploring the feasibility of their implementation. METHODS AND FINDINGS: This study uses a discrete choice experiment (DCE) method to assess the potential resistance of health workers to changing strategies for control of MiP. In Ashanti region in Ghana, 133 antenatal clinic health workers were presented with 16 choice sets of two alternative policy options, each consisting of a bundle of six attributes representing certain clinical guidelines for controlling MiP (type of approach and drug used), possible associated maternal and neo-natal outcomes, workload and financial incentives. The data were analysed using a random effects logit model. Overall, staff showed a preference for a curative approach with pregnant women tested for malaria parasites and treated only if positive, compared to a preventive approach (OR 1.6; p = 0.001). Increasing the incidence of low birth weight or severe anaemia by 1% would reduce the odds of preferring an approach by 18% and 10% respectively. Midwives were more resistant to potential changes to current guidelines than lower-level cadres. CONCLUSIONS: In Ashanti Region, resistance to change by antenatal clinic workers from a policy of SP-IPT to IST would generally be low, and it would disappear amongst midwives if health outcomes for the mother and baby were improved by the new strategy. DCEs are a promising approach to identifying factors that will increase the likelihood of effective implementation of new interventions immediately after their efficacy has been proven. Public Library of Science 2011-08-19 /pmc/articles/PMC3158799/ /pubmed/21886800 http://dx.doi.org/10.1371/journal.pone.0023588 Text en Lagarde et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Lagarde, Mylene
Smith Paintain, Lucy
Antwi, Gifti
Jones, Caroline
Greenwood, Brian
Chandramohan, Daniel
Tagbor, Harry
Webster, Jayne
Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title_full Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title_fullStr Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title_full_unstemmed Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title_short Evaluating Health Workers' Potential Resistance to New Interventions: A Role for Discrete Choice Experiments
title_sort evaluating health workers' potential resistance to new interventions: a role for discrete choice experiments
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158799/
https://www.ncbi.nlm.nih.gov/pubmed/21886800
http://dx.doi.org/10.1371/journal.pone.0023588
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