Satisfaction of Malaria Patients with Care by Community Health Workers Trained in Microscopy: A Mixed-Methods Study in Palawan, the Philippines.

Palawan is the malaria-endemic province with the highest prevalence of malaria in the Philippines, and microscopists (community health workers) have been allowed to deliver early diagnosis and prompt treatment of malaria throughout the province since 1999. To improve the quality of care, the present mixed-methods study attempted to identify the factors associated with satisfaction of patients in Palawan with their microscopists by analyzing the patients' perspectives. First, a quantitative cross-sectional study was conducted among 48 ex-patients and their nine microscopists. Ex-patients were asked about their satisfaction with care, and microscopists were asked about their job satisfaction and ability. Structural equation modeling was conducted for data analysis. Second, a qualitative cross-sectional study was performed using narrative interviews. Data were analyzed using the NVivo 10 software program. As a result, both studies revealed high patient satisfaction with microscopists. The quantitative study showed that ex-patients' satisfaction with their microscopists was independently enhanced by two factors: high ability in malaria microscopic observation and low household wealth of the patients. Particularly, specific subpopulations (those with lower household wealth, relatively old people, and ethnic minorities) were more satisfied with the microscopists' care. The qualitative study strengthens this finding by showing that their microscopists offered prompt and precise diagnosis and effective treatment for free. In conclusion, microscopists were shown to have an important role in narrowing the disparities in malaria care in Palawan. It is important to maintain/enhance the ability of microscopists in malaria microscopy to satisfy their patients.

Factors determining job satisfaction of malaria community microscopists in Palawan, the Philippines: a cross-sectional mixed-methods study.

BACKGROUND: This study was conducted to investigate the overall job satisfaction and its associated factors among microscopists as community health workers who specialize in malaria microscopic diagnosis and treatment in Palawan, the Philippines. The study offered new insights to further lessen the burden of malaria and improve treatment by enhancing their commitment and satisfaction. METHODS: A quantitative study was conducted with 217 microscopists who were asked about their sociodemographic characteristics, ability as microscopists (service quality, knowledge of malaria and ability to diagnose malaria by microscopy [malaria microscopy]) and job satisfaction. Structural equation modelling (SEM) was conducted to analyse these factors. A qualitative study was also conducted and four focus group discussions (FGDs) were carried out. RESULTS: SEM identified that the job satisfaction of microscopists was enhanced by ability in malaria microscopy, the annual parasite index and belonging to ethnic minorities. In the FGDs, high job satisfaction was seen in their devotion to the community and increasing knowledge about malaria. CONCLUSIONS: Providing opportunities to improve malaria microscopy ability would increase the overall job satisfaction of microscopists and eventually improve the quality of care.

Bottom-up approach to strengthen community-based malaria control strategy from community health workers' perceptions of their past, present, and future: a qualitative study in Palawan, Philippines.

BACKGROUND: Microscopists have active roles in bringing malaria diagnosis and treatment closer to households in Palawan, the highest malaria-endemic province in the Philippines. To accelerate the elimination of malaria in Palawan, we performed a study based on the bottom-up approach to provide profound data to strengthen this community-based malaria control from the microscopists' point of view. METHODS: We performed a qualitative cross-sectional study in Palawan. Four focus group discussions with 50 microscopists were conducted in Palawan from November 2010 to February 2011. During the discussions, the following open-ended questions were addressed: motivation for applying to be microscopists in the "Past" category; job satisfaction, role, problems, and saddest and happiest experiences working as microscopists in the "Present" category; and willingness towards task shifting in the "Future" category. Data were transcribed and analyzed by framework analysis using the NVivo software program. RESULTS: The present study innovatively proposed the following strategies: reinforcement strategy (adequate supplies and settings), highly prioritized additional strategies (improving social status of microscopists, issuing a travel budget, and including indigenous populations), regional additional strategies (additional malaria control in the southern region and task shifting in the northern region), and less prioritized additional strategies (employment policy and health checkup). CONCLUSION: A bottom-up approach using microscopists' perceptions would be a valuable method to propose practical and effective additional strategies for strengthening community-based malaria control.