Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa
Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding.Design Quasi-experimental controlled before–after study.Setting Randomly selected primary healthcare clinics (n=24 intervent...
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e034770.full |
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| author | David Sanders Tanya Doherty Nigel Rollins Ameena Goga Max Kroon Samuel Manda Tshifhiwa Nkwenika Lyn Haskins Vaughn John Ingunn M S Engebretsen Ute Feucht Ali Dhansay Shuaib Kauchali Thorkild Tylleskär Christiane Horwood |
| author_facet | David Sanders Tanya Doherty Nigel Rollins Ameena Goga Max Kroon Samuel Manda Tshifhiwa Nkwenika Lyn Haskins Vaughn John Ingunn M S Engebretsen Ute Feucht Ali Dhansay Shuaib Kauchali Thorkild Tylleskär Christiane Horwood |
| author_sort | David Sanders |
| collection | DOAJ |
| description | Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding.Design Quasi-experimental controlled before–after study.Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa.Participants All HWs providing infant feeding counselling in selected facilities were invited.Interventions Three 1–2 hours, on-site workshops over 3–6 weeks.Primary outcome measures Knowledge (22 binary questions), attitude (21 questions—5-point Likert Scale) and confidence (19 questions—3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level.Results In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August–December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups.Conclusion A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs’ knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale. |
| format | Article |
| id | doaj-art-a719f9245dc6410d93304c114a1b10dd |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a719f9245dc6410d93304c114a1b10dd2024-11-16T17:00:07ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2019-034770Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South AfricaDavid Sanders0Tanya Doherty1Nigel Rollins2Ameena Goga3Max Kroon4Samuel Manda5Tshifhiwa Nkwenika6Lyn Haskins7Vaughn John8Ingunn M S Engebretsen9Ute Feucht10Ali Dhansay11Shuaib Kauchali12Thorkild Tylleskär13Christiane Horwood141Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UKHealth Systems Research Unit, South African Medical Research Council, Tygerberg, South AfricascientistHealth Systems Research Unit, South African Medical Research Council, Tygerberg, South AfricaNeonatology, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa13 Biostatistics Unit, South African Medical Research Council, Pretoria, South AfricaBiostatistics Unit, South African Medical Research Council, Tygerberg, South AfricaCentre for Rural Health, University of KwaZulu-Natal, Durban, South AfricaSchool of Education, University of KwaZulu Natal, Pietermaritzburg, South AfricaCentre for International Health, University of Bergen, Bergen, NorwayDepartment of Paediatrics, University of Pretoria, Pretoria, South AfricaDivision of Human Nutrition and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South AfricaNational Department of Health, Pretoria, South AfricaCentre for International health, Universitetet i Bergen, Bergen, NorwayCentre for Rural Health, University of KwaZulu-Natal, Durban, South AfricaObjectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding.Design Quasi-experimental controlled before–after study.Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa.Participants All HWs providing infant feeding counselling in selected facilities were invited.Interventions Three 1–2 hours, on-site workshops over 3–6 weeks.Primary outcome measures Knowledge (22 binary questions), attitude (21 questions—5-point Likert Scale) and confidence (19 questions—3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level.Results In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August–December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups.Conclusion A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs’ knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.https://bmjopen.bmj.com/content/10/10/e034770.full |
| spellingShingle | David Sanders Tanya Doherty Nigel Rollins Ameena Goga Max Kroon Samuel Manda Tshifhiwa Nkwenika Lyn Haskins Vaughn John Ingunn M S Engebretsen Ute Feucht Ali Dhansay Shuaib Kauchali Thorkild Tylleskär Christiane Horwood Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa BMJ Open |
| title | Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa |
| title_full | Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa |
| title_fullStr | Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa |
| title_full_unstemmed | Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa |
| title_short | Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa |
| title_sort | translating new evidence into clinical practice a quasi experimental controlled before after study evaluating the effect of a novel outreach mentoring approach on knowledge attitudes and confidence of health workers providing hiv and infant feeding counselling in south africa |
| url | https://bmjopen.bmj.com/content/10/10/e034770.full |
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