Stigma, Trust, and procedural integrity: Covid-19 testing in Malawi

Area of Science:

• Public Health
• Health Behavior
• Social Science Research

Background:

• Public health strategies increasingly rely on COVID-19 testing for pandemic management.
• Assumed public desire for testing may not hold true in contexts with perceived stigma, low institutional trust, or doubts about procedural integrity.

Purpose of the Study:

• To explore factors influencing willingness to receive free COVID-19 testing in Malawi.
• To investigate the impact of test provider, proximity to illness, and confidentiality assurances on testing intentions.

Main Methods:

• A vignette experiment using a conjoint design was embedded within a phone survey.
• Conducted in Malawi in May 2020, the study manipulated test provider (public clinic vs. international health organization), proximity to illness, and confidentiality reassurance.

Main Results:

• Malawians anticipated higher testing uptake when an international health organization offered the test compared to a public clinic.
• This difference is attributed to greater trust in the international organization and/or perceived procedural integrity.
• Confidentiality reassurance did not significantly impact privacy beliefs but increased doubts about testing willingness at public clinics.

Conclusions:

• The demand for COVID-19 testing is influenced by provider trust and perceived procedural fairness.
• Public health initiatives must consider the demand side of testing, not just supply-side challenges.
• Tailoring testing strategies to local perceptions of health institutions and processes is crucial for effective pandemic management.