Trust in health providers as a catalyst for malaria prevention: Heterogeneous impacts of health education in rural Ghana

Abstract

Although knowledge about effectiveness of insecticide-treated bed nets (ITNs) is fairly widespread in Ghana, their use remains far from universal. We test and validate the hypothesis that health education of hospitals and health centers in rural Ghana is more effective for groups that display relatively high trust to health providers. We estimate heterogeneous impacts of health education on ITN and/or bed net use and on fever as a crude proxy for malaria in the Brong Ahafo and Upper East regions in Ghana, with help of propensity-adjusted regression. The degree of trust in health providers appears to be a key factor in determining the effectiveness of health education in both regions. The effect is not ruled out by controlling for general trust. There are indications of nonlinear effects. The Kassena-Nankana seems to be an exception to this rule—despite low trust in health providers, health education is highly effective for this ethnic group.