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Strengthening Human Immunodeficiency Virus and Tuberculosis Prevention Capacity among South African Healthcare Workers: A Mixed Methods Study of a Collaborative Occupational Health Program

  • 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)
  • 투고 : 2017.02.02
  • 심사 : 2017.08.15
  • 발행 : 2018.06.30

초록

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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참고문헌

  1. United Nations Development Program (UNDP). The 2030 Agenda for Sustainable Development. Geneva: UNDP; 2015.
  2. Yami A, Hamza L, Hassen A, Jira C, Sudhakar M. Job satisfaction and its determinants among health workers in jimma university specialized hospital, southwest ethiopia. Ethiopian J Health Sci 2011;21:19-27.
  3. World Health Organization (WHO). WHO Policy on TB infection control in health-care facilities. Geneva: WHO; 2009.
  4. World Health Organization (WHO), International Labor Organization, Joint United Nations Programme on HIV/AIDS. Joint WHO-ILO-UNAIDS policy guidelines on improving health workers' access to HIV and tuberculosis prevention, treatment, care and support services. Geneva: WHO; 2010.
  5. Jahangiri M, Rostamabadi A, Hoboubi N, Tadayon N, Soleimani A. Needle stick injuries and their related safety measures among nurses in a university hospital, Shiraz, Iran. Saf Health Work 2016;7:72-7. https://doi.org/10.1016/j.shaw.2015.07.006
  6. Yenesew MA, Fekadu GA. Occupational exposure to blood and body fluids among health care professionals in bahir dar town, northwest ethiopia. Saf Health Work 2014;5:17-22. https://doi.org/10.1016/j.shaw.2013.11.003
  7. Sissolak D, Marais F, Mehtar S. TB infection prevention and control experiences of South African nurses - a phenomenological study. BMC Public Health 2011;11:262. https://doi.org/10.1186/1471-2458-11-262
  8. Mehtar S. Lowbury Lecture 2007: infection prevention and control strategies for tuberculosis in developing countries - lessons learnt from Africa. J Hosp Infect 2008;69:321-7. https://doi.org/10.1016/j.jhin.2008.04.015
  9. University Research Co., Tuberculosis in healthcare workers: findings from South Africa; University Research Co. [Internet]. 2008 [cited 2016 Sep 15]. Available from: http://www.urc-chs.com/resources/tuberculosis-healthcare-workers-findings-south-africa
  10. Ward D. The role of education in the prevention and control of infection: a review of the literature. Nurse Educ Today 2011;31:9-17. https://doi.org/10.1016/j.nedt.2010.03.007
  11. Suchitra J, Devi N. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Ind J Med Microbiol 2007;25:181-7. https://doi.org/10.4103/0255-0857.34757
  12. Robson LS, Stephenson CM, Schulte PA, Amick BC. A systematic review of the effectiveness of occupational health and safety training. Scand J Work Environ Health 2012;38:193-208. https://doi.org/10.5271/sjweh.3259
  13. Mehtar S, Marais F, Aucamp M. From policy to practice - education in infection prevention and control. Int J Infect Control [Internet]. 2011 [cited 2017 Aug 26];7(i2). Available from: http://www.ijic.info/article/viewFile/7235/5818. [date accessed: 2016 Feb 21].
  14. World Bank. Empowerment in practice: analysis and implementation. Washington DC: World Bank; 2007.
  15. Mortell M. Hand hygiene compliance: is there a theory-practice-ethics gap? Br J Nurs 2012;21:1011-4. https://doi.org/10.12968/bjon.2012.21.17.1011
  16. Yassi A, Zungu M, Kistnasamy B, Spiegel J, Lockhart K, Jones D, et al. Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships. Global Health 2016;12:10. https://doi.org/10.1186/s12992-016-0145-0
  17. Yassi A, Nophale LE, Dybka L, Bryce E, Kruger W, Spiegel J. Building capacity to secure healthier and safer working conditions for healthcare workers: a South African-Canadian collaboration. Int J Occup Environ Health 2009;15: 360-9. https://doi.org/10.1179/oeh.2009.15.4.360
  18. Liautaud A, Yassi A, Engelbrecht MC, O'Hara LM, Rau A, Bryce EA, Nophale LE. Building capacity to design, implement and evaluate participatory action research projects to decrease the burden of HIV and promote and protect the health and safety of the healthcare workforce: a South African-Canadian Collaboration. Open Med 2013;7:S33.
  19. Bullock A, Morris ZS, Atwell C. Collaboration between health services managers and researchers: making a difference? J Health Services Res Policy 2012;17(Suppl 2):2-10. https://doi.org/10.1258/jhsrp.2011.011099
  20. Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks, California: Sage Publications; 1996.
  21. Merriam SB. Qualitative research and case study applications in education. Thousand Oaks, California: Sage Publications; 1998. Epub 2nd.
  22. Nkoko L, Spiegel J, Rau A, Parent S, Yassi A. Reducing the risks to health care workers from blood and body fluid exposure in a small rural hospital in Thabo-Mofutsanyana, South Africa. Workplace Health Saf 2014;62:382-8. https://doi.org/10.3928/21650799-20140815-03
  23. Verbeek J, Husman K, van Dijk F, Jauhiainen M, Pasternack I, Vainio H. Building an evidence base for occupational health interventions. Scand J Work Environ Health 2004;30:164-70.
  24. Hulshof C, Hoenen J. Evidence-based practice guidelines in OHS: are they agree-able? Industrial Health 2007;45:26-31. PubMed PMID: 17284870. https://doi.org/10.2486/indhealth.45.26
  25. Valim MD, Marziale MHP, Richart-Martinez M, Sanjuan-Quiles A. Instruments for evaluating compliance with infection control practices and factors that affect it: an integrative review. J Clin Nurs 2014;23:1502-19. https://doi.org/10.1111/jocn.12316
  26. Singh A, Purohit B, Bhambal A, Saxena S, Singh A, Gupta A. Knowledge, attitudes, and practice regarding infection control measures among dental students in Central India. J Dental Educ 2011;75:421-7.
  27. Gammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs 2008;17:157-67.
  28. Amponsah-Tawaih K, Adu MA. Work pressure and safety behaviors among health workers in Ghana: the moderating role of management commitment to safety. Saf Health Work 2016;7:340-6. https://doi.org/10.1016/j.shaw.2016.05.001
  29. Sitzmann T, Ely K, Brown K, Bauer K. Self-assessment of knowledge: a cognitive learning or affective measure? Acad Manage Learn Educ 2010;9: 169-91. https://doi.org/10.5465/amle.9.2.zqr169
  30. Engelbrecht M, Yassi A, Spiegel J, van Rensburg A, O'Hara L, Bryce E, Nophale L. Tuberculosis and blood-borne infectious diseases: Workplace conditions and practices of healthcare workers at three public hospitals in the Free State. South Afr J Epidemiol Infect Dis 2015;30:23-8.
  31. Siegel J, Yassi A, Rau A, Buxton J, Wouters E, Engelbrecht M, Uebel KE, Nophale LE. Workplace Interventions to Reduce HIV and TB Stigma among Healthcare Workers - where do we go from here? Global Public Health 2015;13:1-13.
  32. Khan R, Yassi A, Engelbrecht M, Nophale L, van Rensburg A, Spiegel J. Barriers to HIV counselling and testing uptake by health workers in three public hospitals in Free State Province, South Africa. AIDS Care 2014;30:1-8.
  33. Yassi A, O'Hara L, Engelbrecht M, Uebel K, Nophale L, Bryce E, et al. Considerations and dilemmas in preparing a randomized population health intervention trial: lessons from a South Africane-Canadian partnership to improve HIV and tuberculosis prevention and care for health workers. Global Health Action 2014;7(1):23594 [date accessed: 2016 Feb 21], https://doi.org/10.3402/gha.v7.23594.
  34. Moore D, Gamage B, Bryce E, Copes R, Yassi A., British Columbia Interdisciplinary Respiratory Protection StudyGroup. Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines. Am J Infect Control 2005;33:88-96. https://doi.org/10.1016/j.ajic.2004.11.003
  35. Pittet D. Infection control and quality health care in the new millennium. Am J Infect Control 2005;33:258-67. https://doi.org/10.1016/j.ajic.2004.11.004
  36. Baker PA. From apartheid to neoliberalism: health equity in post-apartheid South Africa. Int J Health Serv 2010;40:79-95. https://doi.org/10.2190/HS.40.1.e
  37. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet 2009;374:817-34. https://doi.org/10.1016/S0140-6736(09)60951-X
  38. van Rensburg D. Health and healthcare in South Africa. Van Schaik. 2004. Available from: http://www.takealot.com/health-and-healthcare-in-south- africa/PLID35557641 [date accessed: 2017 Feb 21].
  39. Jansen J, Herman C, Matenjie T, Morake R, Pillay V, Sehoole C, Weber E. Tracing and explaining change in higher education: the South African case. Review of higher education in South Africa. Pretoria: Council on Higher Education; 2007.
  40. Marais H. South Africa pushed to the limit: the political economy of change. South Africa: Zed Books; 2011.

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  2. What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity vol.19, pp.1, 2018, https://doi.org/10.1186/s12960-020-00547-y