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The connection between the perceptions regarding injections and care-seeking preferences can be explained by a common sentiment among Cambodian villagers: ‘public providers at the health centre don’t give injections so we don’t trust them’ ( Ozawa and Walker, 2009). The perceptions around injections, in conjunction with the propensity of private providers to administer them, is a factor in the choice of the source of care with nearly 67% of all healthcare being sought from private providers ( Vong et al., 2005 National Institute of Statistics, Directorate General for Health, and ICF International, 2015). These injections are most commonly administered in the patient’s home (65%) or in a private clinic (20%), with only 13% of injections administered at public hospitals or health centres ( Vong et al., 2005). The private health sector administers >85% of the medical injections in Cambodia ( Vong et al., 2005). Many rural Cambodians perceive injections to be the best quality healthcare one can receive from doctors, and as a result prefer to seek care from providers who prescribe injections as a therapy regardless of the illness, the majority of whom are private providers ( Ministry of Health and UNICEF Cambodia, 2009 Ozawa and Walker, 2011). These rates are much higher in some rural provinces where people may receive an average of four injections per year, with 42% of the population having received a medical injection in the last year ( National Institute of Statistics, Directorate General for Health, and ICF International, 2015). The average number of annual medical injections among the general population is 2.1 and 1.1 for women and men, respectively, with 37% of women and 27% of men having received an injection in the previous 12 months ( National Institute of Statistics, Directorate General for Health, and ICF International, 2015). Unnecessary injections are therapeutic injections that are administered even though oral alternatives are available or the diagnosis does not warrant it ( Simonsen et al., 1999). Interventions to increase knowledge of safe injections and health insurance can aid Cambodia in efforts toward reaching universal health coverage.Ĭambodia has one of the world’s highest rates of overall non-vaccine medical injection usage among the general population, half of which are estimated to be unnecessary ( Gore et al., 2013 Pépin et al., 2013). Providing healthcare information can change people’s trust in health insurance, but may not change people’s trust in healthcare providers. Education of the general populace about safe injection practices and health insurance can contribute toward the country’s efforts to reach universal health coverage.Įducational interventions can successfully increase knowledge about safe injection practices and health insurance in rural Cambodia. However, health information campaigns may not easily influence people’s trust in healthcare providers. These results show that knowledge about injection safety and health insurance, as well as trust in health insurance, can be increased through information dissemination in rural Cambodia. However, trust in healthcare providers proved to be resilient with small to no change. Trust in health insurance increased by 12.9%. Statistical analysis of survey results from the two study arms showed increases of 16.8% and 15.9% in study participant knowledge regarding injections and health insurance, respectively.
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Pre-and post-intervention assessments were used to record the resulting changes in knowledge and trust in providers. Community educational workshops were implemented to improve participant knowledge about injections and health insurance. Using an experimental study design, villages in rural Cambodia were randomly assigned to an intervention or control arm. This study aimed to use an educational intervention to improve participant knowledge about injections and health insurance in order to build informed trust in safer injection practices and health insurance.
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As private providers have a higher propensity to offer injections, patients pursue more expensive care contributing to a greater financial burden. Perceptions in rural Cambodia that medical drug injections provide the best quality medical care have resulted in a large proportion of the population seeking injections across medical conditions. Unnecessary injections increase the risk of blood-borne infections as well as pose an avoidable financial burden on patients.