Strengthening Human Immunodeficiency Virus and Tuberculosis Prevention Capacity among South African Healthcare Workers: A Mixed Methods Study of a Collaborative Occupational Health Program원문보기
Liautaud, Alexandre
(School of Population and Public Health, University of British Columbia)
,
Adu, Prince A.
(School of Population and Public Health, University of British Columbia)
,
Yassi, Annalee
(School of Population and Public Health, University of British Columbia)
,
Zungu, Muzimkhulu
(National Institute for Occupational Health, National Health Laboratory Service)
,
Spiegel, Jerry M.
(School of Population and Public Health, University of British Columbia)
,
Rawat, Angeli
(School of Population and Public Health, University of British Columbia)
,
Bryce, Elizabeth A.
(Vancouver Coastal Health)
,
Engelbrecht, Michelle C.
(Centre for Health Systems Research & Development, University of the Free State)
Background: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Hea...
Background: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Methods: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Results: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Preprogram attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Conclusion: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
Background: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Methods: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Results: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Preprogram attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Conclusion: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
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문제 정의
A workplace-based capacity building Certificate Program can impart improvements in the KASPs needed by HCWs in the areas of OH and IC. Additionally, such a program is able to affect meaningful change within workplaces through the agency of empowered participants leading workplace interventions. Such improvements on a personal and organizational level contribute to increasing HCW health and well-being through improved recognition, job satisfaction, morale, and safety in their workplaces.
There is an urgent need to understand how to best develop and deliver an effective capacity building program for HCWs that addresses their unique occupational and infection prevention hazards with respect to HIV and TB control, while taking into consideration resource constraints. The objective of this study was to examine the effectiveness of a 1-year Certificate Program in Infection Control and Occupational Health in Free State Province, South Africa aimed at empowering HCWs to act as change agents for improving workplace-based HIV and TB prevention. Specifically, we aimed to determine if this Certificate Program was a viable model for: (1) acquiring and improving knowledge, attitudes skills and practices (KASPs) of participants; (2) applying KASPs in their workplace interventions; and (3) effecting meaningful impacts in their workplace through their workplace interventions.
The study responds to the call for more evaluative studies on how to improve OH and IC [23,24]. This training program resulted in improving KASPs in OH and IC, which is consistent with findings of other researchers [25,26].
제안 방법
Detailed field notes were collected daily and analyzed using a wide and narrow perspective to understand viewpoints of individual participants and the context of the program and its institutional and environmental context [21]. A descriptive approach was used to evaluate the group projects at their distinct phases: planning, implementation, and evaluation.
Specifically, we aimed to determine if this Certificate Program was a viable model for: (1) acquiring and improving knowledge, attitudes skills and practices (KASPs) of participants; (2) applying KASPs in their workplace interventions; and (3) effecting meaningful impacts in their workplace through their workplace interventions. In addition, our team tried to determine the extent to which the capacity built among the health workforce was sustainable as well as to document lessons learned in implementing the program.
Quantitative data were obtained from participant self-administered questionnaires and analyzed pre-, mid-, and post-program. Reactions to the program as well as KASPs were measured using a five-point Likert-style scale and true/false questions.
The evaluation extended to 2 months after completion of the Program, and, as such, long-lasting changes could only be inferred from participants’ reports on their intentions to continue to use their capacity to affect further change.
The Certificate Program consisted of three 4-day, face-to-face modules and workplace-based group projects expected to address identified gaps in OH and IC, environmental arrangements, and/or policies/ procedures. The program was intended to impart OH and IC knowledge, skills, and practices, including the basics of HIV and TB prevention, diagnosis, treatment, care, and support. It also provided an overview of healthcare workplace HIV and TB programs, the ethical and sociocultural issues related to workplace research, and relevant legislation, policies, and guidelines.
Wilcoxon signed-rank test identified any significant differences between questionnaire results and background (preprogram questionnaire) characteristics. The same method was used to analyze the significance between the pre-, mid-, and postprogram results for the categories (KASPs) and subcategories of composite scores. In the case of multiple comparisons, a Bonferroni correction was applied according to the number of comparisons that were made.
대상 데이터
The midterm interviews were conducted with 27 of the remaining 28 participants (1 participant being unavailable at the time of interviews, and the remaining 4 having exited the program). Final interviews included 19 of the 28 participants (at which point data saturation was judged to have been reached); all of whom had also been interviewed in the midterm evaluation. Additionally, five of the 12 mentors, all South African, were conveniently sampled and interviewed at completion of the program.
An important feature of this certification program was the undertaking of practical research projects in the workplace, providing an opportunity to apply the knowledge being gained and learn from the challenges being encountered. The eight group projects took place in six distinct settings, where 544 participants (participants of program participants) were surveyed or directly received an intervention. In other cases, groups focused on OH and IC needs assessments or studying the feasibility of implementing a cough registry program and developing associated tools and procedures (Table 3).
Semistructured interview guides were used to provide a richer analysis of participants and local mentors’ experiences. The midterm interviews were conducted with 27 of the remaining 28 participants (1 participant being unavailable at the time of interviews, and the remaining 4 having exited the program). Final interviews included 19 of the 28 participants (at which point data saturation was judged to have been reached); all of whom had also been interviewed in the midterm evaluation.
이론/모형
The program evaluation was guided by an adapted Kirkpatrick framework [19] for assessing training programs. This assessed: (1) reactions to the content and teaching methods of the module and reactions to the projects; (2) learning of KASPs regarding HIV and TB transmission and prevention, OH and IC policies and guidelines, research methods, program implementation and evaluation methods, as well as ethics; (3) behavior changes in work practices, application of knowledge, skills, and practices; and (4) outcomes that originated both from the participants’ reactions, learning, behavior and attitude changes, as well as their projects.
성능/효과
Diminishing retention of knowledge, attitudes, and practices with time was observed by Suchitra and Devi in a 2007 paper [11], in which they described an IC training program and the immediate subsequent improvement in knowledge, attitudes, and practices among HCWs. The evaluative measure was repeated at 6 months, 12 months, and 24 months, and the authors concluded that the degree of improvement declined as time progressed. These findings highlight the need for OH and IC interventions that have impacts long after would-be trainees have forgotten the information imparted to them.
후속연구
Nonetheless, many important advances were made with respect to new policies and programs; for example, the process of conducting needs assessments and identification of OH and IC deficiencies in various workplaces to provide recommendations and inform policy decisions; and a feasibility study for a cough registry program and the subsequent development of tools and procedures for the detection of TB among HCWs and concomitant training of operational managers in the use of these tools and procedures. While further research is necessary to determine whether the considerable resources invested justify the outputs, the magnitude of the problem of HIV and TB in HCWs is such that efforts such as this one need to continue. The complexity of issues involved in successful implementation suggests the desirability of North-South-South collaborations [15] with a strong southern partner that not only can provide technical support during the capacity-building program but also help sustain gains made.
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