Background: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi.
Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify
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aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants.
Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/35187 |
| Date | 20 March 2013 |
| Creators | Puchalski Ritchie, Lisa M. |
| Contributors | Zwarenstein, Merrick |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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