Evaluation of lay health workers' needs to effectively support anti-tuberculosis treatment adherence in Malawi
International Journal of Tuberculosis and Lung Disease
University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Dignitas International, Zomba, Malawi; Dalla Lana School of Public Health, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Dignitas International, Toronto, ON, Canada; Ministry of Health Malawi, Lilongwe, Malawi; George Institute for Global Health, Sydney, NSW, Australia; Sunnybrook Health Sciences Center, Toronto, ON, Canada; University of Sydney, Sydney, NSW, Australia; Knowledge Translation Unit, Lung Institute, University of Cape Town, Cape Town, South Africa; Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
OBJECTIVE: To identify barriers and facilitators to efforts by lay health workers (LHWs) to support antit uberculosis treatment adherence in Malawi to inform the design of a knowledge translation intervention for improving adherence. DESIGN: Qualitative study utilizing focus groups and interviews conducted with LHWs providing tuberculosis (TB) care in Zomba District, Malawi. RESULTS: Participants identified lack of knowledge, both general (understanding of TB and its treatment) and job-specific (understanding of tasks such as completion of treatment forms), as the key barrier to LHWs in their role as adherence supporters. Lack of knowledge among LHWs providing TB care was reported to lead to a lack of confidence, conflicting messages given to patients, poor interactions with patients and errors in documentation. In addition to lack of knowledge, a number of system barriers were identified as limiting LHWs' ability to function optimally, including a lack of physical resources, workload, communication delays and ineffective guardians. CONCLUSION: Our findings suggest a gap between LHW knowledge and their responsibilities as adherence supporters. The results have informed the development of an educational outreach intervention and point-of-care tool, to be evaluated in a randomized trial in Zomba District. © 2012 The Union.
tuberculostatic agent; adult; article; attitude to health; clinical evaluation; female; health care policy; health personnel attitude; human; interpersonal communication; Malawi; male; medical education; medical error; needs assessment; patient compliance; patient counseling; patient education; patient participation; practice guideline; priority journal; professional competence; professional practice; professional secrecy; qualitative research; sex difference; tuberculosis; workload; Adult; Antitubercular Agents; Communication; Community Health Workers; Female; Health Knowledge, Attitudes, Practice; Humans; Malawi; Male; Medication Adherence; Tuberculosis; Workload; Young Adult