Background
Study setting
The intervention
Manual 1 MEMA kwa Vijana developed manual | Manual 2 Ministry of Health and SocialWelfare-developed manual | |
---|---|---|
Duration
| ||
Number of days
| 6 days | 12 days |
Delivery
| ||
Time per day
| 9 am-4 pm | 9 am-6 pm |
Intensity
| Time for breaks and reflection of content | A lot of information intended for each day, making it difficult to complete all the tasks as planned |
Teaching strategy
| Each topic began with participatory brainstorming prior to new material | New material introduced straight away, spot checks were used at the end of each activity |
Ongoing evaluation
| None: evaluation at end of training | Daily evaluation with answers provided |
Intervention materials
| ||
Materials
| Training manual only | Trainers' manual & participant's handout |
Language
| English & Swahili versions | English only |
Content analysis
a
| ||
Refs and details
| No references | For each chapter, there are references and statistics |
Confidentiality
| 1 | 3 |
Rape
| 1 | 3 |
Menstrual cycle
| 1 | 2 |
Condoms
| 1 | 3 |
Gender
| 1 | 2 |
Contraception
| 2 (except condoms) | 1 |
HIV
| 3 | 1 |
STIs
| 3 | 1 |
Stages of Adolescence
| 3 | 1 |
Counselling
| 3 | 1 |
Methods
Design
Date | Implementation activity | Evaluation activity |
---|---|---|
Oct-Nov 2004
|
Training of 24 DTs
| |
6-day training | ||
Jan-June 2005
|
Training with Manual 1:
|
Training evaluation
|
Eight training sessions of 208 health workers (6-day training) | - 16 days observation of five training sessions | |
- 208 pre- & 203 post-training questionnaires | ||
- Informal interviews | ||
Feb-March 2005
| Baseline study
†
: | |
Interviews with 20 HWs prior to receiving the training in 2006 | ||
April 2006
|
Introduction of Manual 2:
| |
12-day training of 24 DTs with MoHSW manual | ||
June 2006
|
Simulated patient study:
| |
One SP visits to 15 health units: eight with trained HWs (intervention) & seven without trained HWs (control) | ||
August 2006
|
Health worker interviews:
| |
Follow-up interviews with 30 HWs from the same health units visited by the SP | ||
Oct 2006 to July 2007
|
Training with Manual 2:
|
Training evaluation
|
Eight training sessions of 221 HWs (12-day training) | - 20 days observation of three - training sessions | |
- 221 pre- & post-training questionnaires | ||
August 2007
|
Follow-up study:
| |
Interviews with 15 MkV-trained HWs, two group discussions & two interviews with non-MkV-trained HWs |
Training evaluation
Facility-level implementation evaluation
Scenario | Details |
---|---|
STI query scenario
| • The young person (YP) is worried that s/he has an STI after having had sex for the first time with a new partner whom s/he has since heard had an STI. |
• YP does not yet have any signs or symptoms. | |
• The YP is also worried his/her parents will find out. | |
Condom request scenario
| • YP requests condoms because he is sexually active, has heard about STDs/HIV, and has heard that condoms may prevent them. |
• YP has also heard that condoms are free at health units. | |
• YP is worried that they contain HIV or that they have holes in them. | |
Family planning request scenario
| • A 16-year-old schoolgirl had sex for the first time one month ago with a boyfriend of 2 months who is also a pupil. |
• She is not using contraception and is worried about getting pregnant. | |
• She knows very little about contraceptives, wants to avoid pregnancy, and is afraid to talk her parents |
Analysis
2005 | 2006 |
2006 v 2005
†
| |||||||
---|---|---|---|---|---|---|---|---|---|
% of HWs with all correct/desired answers
|
Pre
n = 208
|
Post
n = 203
|
RR (95% CI)
|
Pre
n = 221
|
Post
n = 225
| RR (95 % CI) |
P value
| ||
Knowledge on
| |||||||||
HIV/AIDS
| 78.8 | 87.1 | 1.11* | (1.00, 1.21) | 91.8 | 99.6 | 1.08** | (1.04, 1.13) |
p = 0.32
|
puberty
| 83.3 | 93.6 | 1.12** | (1.05, 1.22) | 81.2 | 85.9 | 1.06* | (1.02, 1.16) |
p = 0.19
|
STDs
| 34.5 | 29.8 | 0.86 | (0.63, 1.18) | 28.9 | 57.7 | 2.00** | (1.54, 2.59) |
p < 0.001
|
Attitude relating to
| |||||||||
stigma
| 89.0 | 94 | 1.06 | (0.98, 1.12) | 80.5 | 93.1 | 1.16** | (1.07, 1.26) |
p < 0.001
|
young people
| 77.1 | 97.3 | 1.26** | (1.15, 1.38) | 69.9 | 92.2 | 1.32** | (1.19, 1.47) |
p = 0.02
|
condoms
| 96.4 | 97 | 1.01 | (0.97, 1.04) | 96.7 | 97.3 | 1.01 | (0.97, 1.04) |
p = 1
|
Condoms use amongst school pupils
| 83.3 | 97.5 | 1.17 | (0.98, 1.06) | 90.7 | 96.4 | 1.06* | (1.01, 1.12) |
p < 0.001
|
Confidentiality
| 66.7 | 82.2 | 1.23** | (1.09, 1.41) | 67.6 | 92.0 | 1.36** | (1.22, 1.52) |
p < 0.001
|
Young people's right to treatment
| 56.4 | 74.9 | 1.33** | (1.17, 1.60) | 54.6 | 74.5 | 1.36** | (1.17, 1.60) |
p = 0.21
|
Ethics
Results
Evaluation of the training
Coverage
Training implementation
Impact of training on health worker knowledge and attitudes
Evaluation of the implementation of youth-friendly services at facility level
Health workers' attitudes and experience of reproductive health services at baseline
Health worker attitudes and experience of reproductive health services at follow up
Impact on the perceived "friendliness" of health service delivery to young people
STI scenario | Family planning scenario | Condom request | ||||
---|---|---|---|---|---|---|
Cont
‡
|
Int
†
|
Cont
‡
|
Int
†
|
Cont
‡
|
Int
†
| |
Number of SP visits | 2 | 3 | 2 | 3 | 3 | 2 |
Area (possible score per SP)
|
Average score (% of total possible score)
| |||||
Welcome (4)a
| 2.0 (50%) | 0.7 (18%) | 1.5 (38%) | 1.7 (43%) | 1.7 (43%) | 3.0 (75%) |
Information (2) b
| 0.5 (25%) | 0.0 (0%) | 0.0 (0%) | 1.0 (50%) | 0.7 (35%) | 0.5 (25%) |
Counseling (4) c
| 3.0 (75%) | 0.7 (18%) | 2.0 (50%) | 3.3 (83%) | 1.3 (33%) | 4.0 (100%) |
General attitudes(10) d
| 6.5 (65%) | 2.3 (23%) | 5.0 (50%) | 6.7 (67%) | 3.3 (33%) | 5.5 (55%) |
Privacy (6) e
| 3.0 (50%) | 2.7 (45%) | 3.0 (50%) | 6.0 (100%) | 0.0 (0%) | 6.0 (100%) |
Total (31)
|
-
Clinician: What is your name?
-
Clinician: Where do you live?
-
Clinician: How old are you?
-
Clinician" What is your problem?
-
SP: [SP recounted the condom scenario (see Table 3)]
-
Clinician: Do you feel pain at all when you urinate?
-
SP: No
-
Clinician: You must come with 1500/= so that you can be tested
-
END OF CONSULTATION -