Utilisation of diagnostics in India: a rapid ethnographic study exploring context and behaviour

Area of Science:

• Medical Diagnostics
• Health Services Research
• Qualitative Research

Background:

• Caregiver utilization of diagnostic tests is crucial for timely and appropriate treatment of sick children.
• Understanding factors influencing caregiver behavior in diagnostic test use is essential for improving healthcare outcomes.
• Optimizing diagnostic test use can lead to targeted treatment and responsible antibiotic stewardship.

Purpose of the Study:

• To explore factors influencing caregiver behavior in the utilization of diagnostic tests for sick children.
• To identify barriers and facilitators to diagnostic test uptake and follow-up among caregivers.
• To inform the development of interventions aimed at improving diagnostic test utilization.

Main Methods:

• Rapid ethnographic qualitative study involving unstructured and structured observations.
• Semi-structured interviews with 43 caregivers of sick children.
• Inductive thematic analysis of transcripts, analyzed through the Capability, Opportunity, Motivation, and Behaviour (COM-B) model.

Main Results:

• Caregivers generally trust and understand the importance of diagnostics, but acceptance varies with illness severity and preference for direct medication.
• Significant barriers to diagnostic utilization include delays in testing, result delivery, and follow-up, compounded by travel time, distance, and competing priorities.
• Costs associated with tests, travel, and lost wages present substantial financial barriers for caregivers.

Conclusions:

• While diagnostics are accepted, the organization of services and associated costs impede caregiver utilization.
• Enhancing the accessibility and affordability of diagnostic services is key to increasing caregiver motivation and ensuring follow-up.
• Interventions addressing logistical and financial barriers are needed to improve diagnostic test use in pediatric care.