Optimizing Audit and Feedback in Low-Resource Settings: A Best-Worst Scaling Study of Healthcare Workers Preference in Zanzibar

Background Adherence to clinical guidelines is crucial for providing high-quality primary healthcare services. However, low- and middle-income countries (LMICs) like Zanzibar often face challenges adhering to the guidelines. Audit and feedback (A&F) mechanisms can play a significant role in identifying areas for improvement and promoting guideline compliance. Traditional feedback methods may not effectively prioritize the most impactful changes. Best-worst scaling (BWS) can provide a more nuanced approach to understanding preferences and priorities among healthcare practitioners. This study aims at optimizing feedback strategy by determining which components health workers prioritize. Methods This mixed-method study was done under two methodological approaches a) expert consultation and b) Best-worst scaling. Expert consultation was conducted to seek expert opinions on the various feedback components obtained from the literature. This was done through expert meetings and questionnaires. Three meetings were conducted and two rounds of questionnaires were distributed. A BWS survey was done to find the prioritized components from the primary healthcare workers. A series of questions was presented to them arranged in blocks to select the most important (best) and the least (worst) important components. Data were collected in an online platform called REDcap and analyzed using R software version 4.4.2 Results "Feedback with an improvement plan" was the highest-ranked component ( p  < 0.001), "Feedback with goals/targets" was the second-ranked component ( p  < 0.001), and "Delivery method of feedback" was the third-ranked feedback component ( p  < 0.001). "Feedback with peer comparison", the "Format of the feedback report", and the "Source of feedback" had negative mean scores ( p  = 0.0200, p  = 0.0217, and p  = 0.3408 respectively). "The Feedback recipient" component had the smallest mean score. This indicates that these are less important feedback components than others. Conclusion The findings from this study have found that the most preferred feedback components among health workers are "Feedback with an Improvement Plan," "Feedback with Goals/Targets," and "Delivery Method of Feedback". This suggests that they need feedback which is actionable, Goals oriented and well delivered. The findings therefore have given us ways to improve the technique we use to give feedback, enhance guidelines adherence, and, therefore, improve the quality of primary healthcare services.