A qualitative and geospatial analysis of medicine retailer behaviors in western Kenya: Implications for malaria treatment and control policy

Andria E Rusk, The University of Texas School of Public Health

Abstract

Medicine retailers are at the forefront of malaria treatment and control in this region because most people seek treatment for febrile illness first in retail drug shops. This work endeavored to provide context to the determinants to medicine retailer behavior, and discover whether under or unutilized methods exist that could help us understand their behaviors, in order to improve malaria case management in Kenya.^ To do this, both qualitative and quantitative methods were employed. Six focus groups were conducted, and a quantitative survey administered, to those medicine retailers working in drug shops that are within or accessible to those living within the Webuye Demographic Surveillance Site (WHDSS). The focus group discussions were examined using content analysis to discover the perceptions medicine retailers had of their roles. The survey data was analyzed for spatial clusters using SaTScan, and for spatial heterogeneity using geographic weighted regression.^ Within the qualitative data, evidence for role ambiguity and role conflict was found among medicine retailer perceptions of their role. Retailers conveyed perceptions of their role as physicians, medicine dispensers, businesspersons, and caretakers. Retailers’ perceptions of how customers viewed their roles included those who offer diagnostic testing, medicine dispensers, and drug sellers interested in a profit. The existence of multiple roles results is evidence for role ambiguity as it clouds the expectations for medicine retailer performance. The contradiction between roles, when fulfillment of two sets of expectations is impossible, is evidence for role conflict.^ The cluster analysis of survey data found several statistically significant spatial clusters, indicating that medicine retailer behaviors have geographic variation. Variables with statistically significant clusters included having training in pharmacy, recommending the appropriate antimalarial medication to adults, and selling that medication more than other antimalarials. The results of the geographic weighted regression yielded statistically significant associations between determinants and outcome behaviors that vary across space, indicating that spatial heterogeneity exist in the data. These determinants to medicine retailer behavior included having a health-related training, knowing the MOH-recommended firstline antimalarial therapy, and attending a malaria workshop.^ This work discovered that medicine retailers operate within a multifaceted context, involving influence from their training, their customers, regulatory agencies, and their collegial neighbors. This effort also underscores the benefits of using quantitative and qualitative approaches to provide a richer context than using one method alone.^

Subject Area

Behavioral psychology|Public health

Recommended Citation

Rusk, Andria E, "A qualitative and geospatial analysis of medicine retailer behaviors in western Kenya: Implications for malaria treatment and control policy" (2015). Texas Medical Center Dissertations (via ProQuest). AAI3720288.
http://digitalcommons.library.tmc.edu/dissertations/AAI3720288

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