减少医疗机构工作人员对艾滋病病毒的污名化:混合式学习干预措施的开发
HIV Stigma Reduction for Health Facility Staff: Development of a Blended- Learning Intervention.
作者信息
Nyblade Laura, Srinivasan Krishnamachari, Mazur Amanda, Raj Tony, Patil Divya S, Devadass Dhinagaran, Radhakrishna Kedar, Ekstrand Maria L
机构信息
Global Health Division, International Development Group, RTI International, Washington, DC, United States.
St. Johns Research Institute, Bangalore, India.
出版信息
Front Public Health. 2018 Jun 21;6:165. doi: 10.3389/fpubh.2018.00165. eCollection 2018.
The effect of stigma on health and health inequity is increasingly recognized. While many medical conditions trigger stigmatization, the negative effects of HIV stigma are particularly well documented. HIV stigma undermines access, uptake, and adherence to both HIV prevention and treatment. People living with HIV face stigma in all aspects of their daily lives; however, stigma in the health system is particularly detrimental. A key component for health facility stigma-reduction interventions is participatory training of staff, often through several days of in-person training. Though this approach shows promise, it is time intensive and poses challenges for busy health facilities. In response, the DriSti study has developed a brief blended-learning approach to stigma reduction in Karnataka State, India. This paper describes the process and final content of the intervention development. The intervention is currently being tested. Final evaluation results will be published upon study completion. Grounded in behavior change strategies based on social cognitive theory principles that stress the importance of combining interpersonal interactions with specific strategies that promote behavior change, we used a three-phase approach to intervention development: (1) content planning-review of existing participatory stigma-reduction training activities; (2) story boarding-script development and tablet content production; and (3) pilot testing of tablet and in-person session materials. The final intervention curriculum consists of three sessions. Two initial self-administered tablet sessions focus on stigma awareness, attitudes, fears of HIV transmission, and use of standard precautions. The third small group session covers the same material but includes skill building through role-play and testimony by a person living with HIV. A study team member administers the tablet sessions, explains the process, and is present throughout to answer questions. This paper describes the theoretical underpinning and process of developing the blended-learning curriculum content, and practical lessons learned.The approach covers three key drivers of HIV stigma-stigma awareness, fear of HIV transmission, and attitudes. Developing video content for the self-directed learning is complex, requires a diverse set of people and skills, and presents unexpected opportunities for stigma reduction. Co-facilitation of the in-person session by someone living with HIV is a critical component.
耻辱感对健康及健康不平等的影响日益受到认可。虽然许多疾病状况都会引发耻辱感,但关于艾滋病毒耻辱感的负面影响已有详尽记录。艾滋病毒耻辱感会妨碍艾滋病毒预防和治疗的获取、接受及坚持。艾滋病毒感染者在日常生活的方方面面都面临耻辱感;然而,卫生系统中的耻辱感尤其有害。减少医疗机构耻辱感干预措施的一个关键组成部分是对工作人员进行参与式培训,通常是通过为期数天的面对面培训。尽管这种方法显示出前景,但耗时较长,给忙碌的医疗机构带来了挑战。作为回应,“减少耻辱感”(DriSti)研究在印度卡纳塔克邦开发了一种简短的混合学习方法来减少耻辱感。本文描述了干预措施开发的过程和最终内容。该干预措施目前正在进行测试。最终评估结果将在研究完成后公布。基于社会认知理论原则的行为改变策略,强调将人际互动与促进行为改变的特定策略相结合的重要性,我们采用了三阶段方法来进行干预措施开发:(1)内容规划——审查现有的参与式减少耻辱感培训活动;(2)故事板制作——脚本编写和平板电脑内容制作;(3)平板电脑及面对面课程材料的试点测试。最终的干预课程包括三个环节。最初的两个自我管理的平板电脑环节聚焦于耻辱感意识、态度、对艾滋病毒传播的恐惧以及标准预防措施的使用。第三个小组环节涵盖相同的内容,但包括通过角色扮演和艾滋病毒感染者的证言来进行技能培养。一名研究团队成员管理平板电脑环节,解释流程,并全程在场回答问题。本文描述了混合学习课程内容开发的理论基础和过程,以及所汲取的实际经验教训。该方法涵盖了艾滋病毒耻辱感的三个关键驱动因素——耻辱感意识、对艾滋病毒传播的恐惧以及态度。为自主学习开发视频内容很复杂,需要各种各样的人员和技能,并且为减少耻辱感带来了意想不到的机会。由艾滋病毒感染者共同主持面对面课程是一个关键组成部分。