Dewing Sarah, Mathews Cathy, Cloete Allanise, Schaay Nikki, Simbayi Leickness, Louw Johann
Health Systems Research Unit.
HIV/AIDS, STIs and TB Research Programme.
J Consult Clin Psychol. 2014 Feb;82(1):19-29. doi: 10.1037/a0034659. Epub 2013 Oct 7.
Options for Health is an evidence-based sexual risk reduction intervention based on motivational interviewing (MI). Thirty-nine antiretroviral adherence lay counselors were trained to deliver Options for Health to help their patients to optimize their antiretroviral treatment adherence. An evaluation of counselors' ability to deliver the intervention after 35 hr of training revealed that counselors struggled with elements of the 8-step Options protocol and failed to achieve proficiency in MI. The current study aimed to determine the impact of refresher training and supervision on counselors' proficiency in the intervention.
Audio-recordings of counseling sessions were collected for 22 of 39 counselors after 18 hr of refresher training and supervision had been delivered over a 12-month period. Recordings were transcribed, translated, and analyzed for fidelity to the Options protocol and the MI approach. Analysis was conducted using the Motivational Interviewing Treatment Integrity Tool and an instrument developed by the researchers. Results were compared to findings from an evaluation of counselors' performance immediately following the initial 35-hr training.
Counselors improved their delivery of some intervention steps, but not others; their use of micro-counseling skills and therapeutic approach improved to such an extent that they closely approximated the MI approach.
This study contributes evidence for the positive impact of ongoing training and supervision on lay health worker practice. Although counselors did not achieve complete proficiency in the Options protocol, refresher training and supervision improved counselors' basic counseling communication skills and therapeutic approach, enabling them to deliver better quality counseling for behavior change.
“健康选择”是一种基于动机性访谈（MI）的循证性降低性风险干预措施。39名抗逆转录病毒依从性外展咨询师接受了培训，以提供“健康选择”干预措施，帮助他们的患者优化抗逆转录病毒治疗的依从性。对咨询师在35小时培训后实施该干预措施的能力进行的评估显示，咨询师在8步“健康选择”方案的某些环节上遇到困难，未能熟练掌握动机性访谈。本研究旨在确定强化培训和督导对咨询师干预熟练度的影响。
在12个月的时间里，对39名咨询师中的22名进行了18小时的强化培训和督导后，收集了咨询会话的音频记录。对记录进行转录、翻译，并分析其对“健康选择”方案和动机性访谈方法的忠实度。使用动机性访谈治疗完整性工具和研究人员开发的一种工具进行分析。将结果与初始35小时培训后立即对咨询师表现进行评估的结果进行比较。
咨询师在某些干预步骤的实施上有所改进，但其他步骤没有；他们对微咨询技巧和治疗方法的运用有了很大改进，几乎接近动机性访谈方法。
本研究为持续培训和督导对非专业卫生工作者实践的积极影响提供了证据。尽管咨询师在“健康选择”方案中没有完全达到熟练程度，但强化培训和督导提高了咨询师的基本咨询沟通技巧和治疗方法，使他们能够提供更高质量的行为改变咨询服务。
