title: Motivation and challenges for use of malaria rapid diagnostic tests among informal providers in Myanmar: a qualitative study.
abstract: BACKGROUND
  Rapid diagnostic tests (RDTs) for malaria enable proper diagnosis and have been shown to reduce overuse of artemisinin combination therapy. Few studies have evaluated the feasibility and use of RDTs in the private sector in Myanmar. The objectives of the study were to: 1) understand the acceptability of using RDTs in the informal sector in Myanmar; 2) examine motivations for use among informal providers; and, 3) highlight decision-making and knowledge of providers for diagnostic testing and treatment.
  
  
  METHODS
  Qualitative interviews were conducted with 30 informal providers. Purposeful sampling was used to enrol study participants in the Mon and Shan State in Myanmar. All interviews were conducted in Burmese, translated into English, and two researchers coded all interviews using Atlas ti.
  
  
  RESULTS
  Major themes identified included: 1) informal provider and outlet characteristics, including demographic and background characteristics; 2) the benefits and challenges of using RDTs according to providers; 3) provider experiences with using RDTs, including motivations for using the RDT; 4) adherence to test results, either positive or negative; and, 5) recommendations from informal providers to promote increased use of RDTs in their communities. This study found that introducing RDTs to informal providers in Myanmar was feasible, resulting in improved provider empowerment and patient-provider relationships. Specific challenges included facility infrastructure to use and dispose RDTs and provider knowledge. This varied across the type of informal provider, with itinerant drug vendors more comfortable and knowledgeable about RDTs compared to general retail sellers and medical drug representatives.
  
  
  CONCLUSIONS
  This study found informal providers in Myanmar found the introduction of RDTs to be highly acceptable. Providers discussed improvement in service quality including provider empowerment and patient-provider relationships. The study also highlighted a number of challenges that informal providers face which may be used for future development of interventions.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. May.Sudhinaraset@ucsf.edu.|Global Health Group, Global Health Sciences, University of California, San Francisco, CA, USA. May.Sudhinaraset@ucsf.edu.
authors.forename: May
authors.initials: M
authors.lastname: Sudhinaraset
authors.affiliation: Global Health Group, Global Health Sciences, University of California, San Francisco, CA, USA. chbriegleb@gmail.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Briegleb
authors.affiliation: Population Services International, Yangon, Myanmar. moeaung.mri@gmail.com.
authors.forename: Moe
authors.initials: M
authors.lastname: Aung
authors.affiliation: Population Services International, Yangon, Myanmar. hsskhin@psimyanmar.org.
authors.forename: Hnin Su Su
authors.initials: HS
authors.lastname: Khin
authors.affiliation: Population Services International, Yangon, Myanmar. taung@psimyanmar.org.
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
mesh_terms: D000328:Adult; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D002052:Myanmar; D017149:Private Sector