title: Evaluating health workers' potential resistance to new interventions: a role for discrete choice experiments.
abstract: 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.
  
  
  RESULTS
  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.
authors: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. Mylene.Lagarde@lshtm.ac.uk
authors: Mylene
authors: M
authors: Lagarde
authors: Lucy
authors: L
authors: Smith Paintain
authors: Gifti
authors: G
authors: Antwi
authors: Caroline
authors: C
authors: Jones
authors: Brian
authors: B
authors: Greenwood
authors: Daniel
authors: D
authors: Chandramohan
authors: Harry
authors: H
authors: Tagbor
authors: Jayne
authors: J
authors: Webster
mesh_terms: D000328:Adult; D000375:Aging; D002755:Choice Behavior; D004338:Drug Combinations; D005069:Evaluation Studies as Topic; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006282:Health Personnel / Q000706:statistics & numerical data*; D006287:Health Planning Guidelines; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D008880:Midwifery / Q000706:statistics & numerical data; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use
chemical_list: D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine