Utilisation of diagnostics in India: a rapid ethnographic study exploring context and behaviour
Bronwen Holloway1, Aditya Mathur2, Ashish Pathak2,3
1Department of Womens and Childrens Health, Uppsala Global Health Research on Implementation and Sustainability, Uppsala University, Uppsala, Sweden bronwen.holloway@kbh.uu.se.
Insights
Caregiver acceptance of diagnostic tests for sick children is high, but access and cost barriers hinder utilization. Improving diagnostic service organization and affordability can enhance uptake and follow-up for better treatment.
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.
Objectives:
To explore factors that influence behaviour in the utilisation of diagnostics by caregivers of sick children. Utilisation is defined as a caregiver assisting a child to get diagnostic tests done and return for follow-up of results. Understanding these experiences may help inform the development of interventions and implementation strategies to improve the use of diagnostics, thereby target treatment and optimise antibiotic use.
Design:
A rapid ethnographic qualitative study using 3 months of unstructured observations, 1 month of structured observations of diagnostic utilisation and 43 semi-structured interviews. Transcripts were coded and analysed using inductive thematic analysis. Findings were explored from a behavioural perspective through the lens of the 'Capability, Opportunity, Motivation and Behaviour' (COM-B) model for understanding behaviour. The multiple methods of investigation applied allowed for triangulation and cross-validation of the findings.
Setting:
The paediatric outpatient department of a teaching hospital in rural, central India.
Participants:
Caregivers of sick children attending the paediatric outpatient department who were sent for one or more diagnostic test.
Results:
Three key themes were identified that influenced caregivers' behaviour. Caregivers trusted and understood the importance of diagnostics but their acceptance wavered depending on the severity of illness and preference to treat their child directly with medicines. Caregivers struggled to access diagnostics, describing delays in testing, receiving results and follow-up, further complicated by travel time, distance and competing priorities such as work. Diagnostics were relatively cheap compared with other healthcare facilities however, the cost of the test, travel expenses and wages lost for missing work, were barriers to getting the tests done and returning for follow-up.
Conclusions:
Diagnostics are generally accepted and their purpose understood, however, the organisation of diagnostic services, direct and indirect costs hinder caregivers from using diagnostics. Improvements in accessibility and affordability may increase caregiver motivation to use diagnostics and return for follow-up.
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