title: How do risk preferences relate to malaria care-seeking behavior and the acceptability of a new health technology in Nigeria?
abstract: BACKGROUND
  To reduce the burden of disease from malaria, innovative approaches are needed to engender behavior change. One unobservable, but fundamental trait-preferences for risk-may influence individuals' willingness to adopt new health technologies. We explore the association of risk preferences with malaria care-seeking behavior and the acceptability of malaria rapid diagnostic tests (RDTs) to inform RDT scale-up plans.
  
  
  METHODS
  In Oyo State, Nigeria, adult customers purchasing anti-malarial medications at selected drug shops took surveys and received an RDT as they exited. After an initial risk preference assessment via a simple lottery game choice, individuals were given their RDT result and treatment advice, and called four days later to assess treatment adherence. We used bivariable and multivariable regression analysis to assess the association of risk game choices with malaria care-seeking behaviors and RDT acceptability.
  
  
  RESULTS
  Of 448 respondents, 63.2% chose the lottery game with zero variance in expected payout, 27.9% chose the game with low variance, and 8.9% chose the game with high variance. Compared to participants who chose lower variance games, individuals choosing higher variance games were older, less educated, more likely to be male, and were more likely to patronize lower quality drug shops, seek care immediately, and report complete disability due to their illness. In contrast, individuals choosing lower variance games were more likely to follow the correct treatment directions and were more likely to report an increase in their willingness to pay for an RDT compared to other risk groups, our two measures of RDT acceptability. Differences in estimated associations between risk game choices and selected care-seeking behaviors remained after controlling sociodemographic confounders.
  
  
  CONCLUSIONS
  The uptake of health diagnostic information in terms of translating the RDT experience into willingness to pay for an RDT and treatment adherence to test results may vary according to risk preferences. Hence, health promotion communications may want to be crafted bearing in mind differences in uptake among people of different risk preferences to encourage wider RDT adoption and more rational malaria treatment. Estimates will serve as the basis for power calculations for an expanded study.
authors.affiliation: Global Health Sciences, University of California, San Francisco, 550 16th Street, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA 94158, USA. liuj@globalhealth.ucsf.edu.
authors.forename: Jenny
authors.initials: J
authors.lastname: Liu
authors.forename: Sepideh
authors.initials: S
authors.lastname: Modrek
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anyanti
authors.forename: Ernest
authors.initials: E
authors.lastname: Nwokolo
authors.forename: Anna
authors.initials: A
authors.lastname: De La Cruz
authors.forename: Eric
authors.initials: E
authors.lastname: Schatzkin
authors.forename: Chinwoke
authors.initials: C
authors.lastname: Isiguzo
authors.forename: Chinazo
authors.initials: C
authors.lastname: Ujuju
authors.forename: Dominic
authors.initials: D
authors.lastname: Montagu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004059:Diffusion of Innovation; D005260:Female; D015438:Health Behavior; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008288:Malaria / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D011933:Reagent Kits, Diagnostic; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic