title: The development of effective behaviour change interventions to support the use of malaria rapid diagnostic tests by Tanzanian clinicians.
abstract: BACKGROUND
  Parasitological confirmation is now recommended for all cases of suspected malaria. The roll-out of rapid diagnostic tests (RDTs) is hoped to enable this goal in low resource settings through point of care testing. However, simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians, with malaria continuing to be overdiagnosed in many settings. We undertook to design an evidence-based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania, to be evaluated through the Targeting Artemisinin Combination Therapy (TACT) cluster randomised controlled trial.
  
  
  METHODS
  We describe five steps in our intervention design: formative research, review of existing evidence and theory, a workshop to define the intervention approach and content and results of formative research, engagement with behaviour change theory and literature, detailed design of intervention materials and piloting and pretesting of intervention materials. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania.
  
  
  RESULTS
  The formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction, but that health workers used various techniques to resolve this, including provision of antimalarial drugs for RDT-negative patients. Our reviews showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice. Our design process is presented, drawing from this collective evidence. We describe the final TACT intervention package (including interactive small group workshops, feedback text messages, motivational text messages and patient information leaflets and posters) in terms of its programme theory and implementation theory.
  
  
  CONCLUSIONS
  Our study suggests that evidence-based design of complex interventions is possible. The use of formative research to understand malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test materials and methods prior to implementation. The TACT interventions may be appropriate for other settings where clinicians face similar challenges with malaria diagnostics.
  
  
  BACKGROUND
  NCT01292707.
authors: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. clare.chandler@lshtm.ac.uk.
authors: Clare I R
authors: CI
authors: Chandler
authors: Judith
authors: J
authors: Meta
authors: Célia
authors: C
authors: Ponzo
authors: Fortunata
authors: F
authors: Nasuwa
authors: John
authors: J
authors: Kessy
authors: Hilda
authors: H
authors: Mbakilwa
authors: Ane
authors: A
authors: Haaland
authors: Hugh
authors: H
authors: Reyburn
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use; D004493:Education; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000458:organization & administration* / Q000592:standards; D011933:Reagent Kits, Diagnostic / Q000706:statistics & numerical data*; D013636:Tanzania / Q000453:epidemiology; D018581:Technology Transfer
chemical_list: D018692:Antimanic Agents; D011933:Reagent Kits, Diagnostic