Kukafka Rita, Millery Mari, Chan Connie, LaRock William, Bakken Suzanne
Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, NY, USA.
AIDS Care. 2009 Jan;21(1):103-8. doi: 10.1080/09540120802033864.
Psychosocial counselors have a vital and challenging role in supporting persons living with HIV/AIDS (PLWH/A) to better manage their disease. However, gaps in training, education, and skills limit the effectiveness of counselors' efforts. We propose that the use of a decision-support tool for counselors at the point of care can support them in their work as well as help alleviate many training and practice gaps. Decision-support tools aimed at reducing knowledge and practice gaps are used extensively to assist clinical providers at the point of care; however, there is a need for decision-support tools designed specifically for HIV/AIDS counselors. To identify requirements for such a tool, we conducted a needs assessment through interviews of 19 HIV/AIDS clinic counselors who provide 20 or more hours per week of psychosocial support to PLWH/A. The assessment explored their education and training backgrounds, the extent to which evidence-based practices are implemented, and how a decision-support tool can support counselor work practices. Qualitative analysis was organized around seven main categories: counselor characteristics, patient characteristics, barriers, definitions of key concepts, use of guidelines, client assessments, and resources. The resulting coding schemes revealed knowledge and practice gaps among the interviewees, as well as barriers and challenges of counseling. Education and training background of the counseling staff varied widely. When asked to define five key concepts related to HIV counseling, 26-47% of respondents were unable to articulate an adequate definition. Less than half of the interviewees recalled sources of guidelines used in their work and specific models of care introduced during trainings. Interviews identified environmental barriers, language and literacy, patient education, and patient communication as the most prominent challenges to counseling work. The results from this study inform the need for and development of a decision-support tool to support the training and practices of HIV/AIDS counselors.
心理社会咨询师在支持艾滋病毒/艾滋病感染者（PLWH/A）更好地管理自身疾病方面发挥着至关重要且具有挑战性的作用。然而，培训、教育和技能方面的差距限制了咨询师工作的成效。我们建议，在护理点为咨询师使用决策支持工具，既能辅助他们的工作，又有助于缓解诸多培训和实践方面的差距。旨在减少知识和实践差距的决策支持工具被广泛用于协助护理点的临床提供者；然而，专门为艾滋病毒/艾滋病咨询师设计的决策支持工具仍有需求。为确定此类工具的要求，我们通过对19名艾滋病毒/艾滋病诊所咨询师进行访谈开展了一项需求评估，这些咨询师每周为PLWH/A提供20小时及以上的心理社会支持。该评估探讨了他们的教育和培训背景、循证实践的实施程度，以及决策支持工具如何能辅助咨询师的工作实践。定性分析围绕七个主要类别展开：咨询师特征、患者特征、障碍、关键概念的定义、指南的使用、客户评估和资源。所得的编码方案揭示了受访者之间的知识和实践差距，以及咨询工作中的障碍和挑战。咨询人员的教育和培训背景差异很大。当被要求定义与艾滋病毒咨询相关的五个关键概念时，26%至47%的受访者无法给出充分的定义。不到一半的受访者能回忆起工作中使用的指南来源以及培训期间引入的具体护理模式。访谈确定环境障碍、语言和读写能力、患者教育以及患者沟通是咨询工作最突出的挑战。本研究结果表明需要开发一种决策支持工具来支持艾滋病毒/艾滋病咨询师的培训和实践。
