BACKGROUND
Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny of private providers’ intentions, motives and obstacles to comply with infectious disease surveillance. Appreciation of how private providers’ attitudes shape their TB notification behaviors yields lessons for surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among institutions is an under-studied part of the “software” of surveillance.
OBJECTIVE
We aimed to assess self-reported knowledge, motivation, barriers, and case notification behavior to public health authorities in Lagos, Nigeria. We sought to compare self-report against actual notifications received and cases found in facility records.
METHODS
A geographically representative, stratified sample of 278 private health care workers (HCWs) was surveyed using an adapted version of the citizen trust scale and self-reported surveillance behavior was contrasted with actual facility case counts.
RESULTS
Noncompliance with legal obligations to notify infectious diseases was not due to a lack of knowledge. Mean trust in public health scores were higher in those who notified cases via the Infectious Disease Surveillance Registry (IDSR) than those who did not [44.8, SE= 0.74 vs. 41.6, SE = 0.50,t(250)=3.76, p< .001, r=.231]. In a multivariable model, trust in public health authorities was the only predictor of comfort with disease notification. While self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, self-report did not tally with actual notifications. Survey methods overestimated surveillance behavior.
CONCLUSIONS
Providers perceive both risks and benefits to recording and reporting. In order to improve private providers’ public health behaviors, policymakers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. A renewed attention to the ‘software’ of health systems (e.g. norms, values, and relationships) is vital to address pandemic threats.