Kjærgaard Jesper, Nissen Thomas Nørrelykke, Isaeva Elvira, Quynh Nguyen Nhat, Reventlow Susanne, Lund Stine, Sooronbaev Talant, Le An Pham, Østergaard Marianne Stubbe, Stout Jim, Poulsen Anja
Global Health Unit, Department of Paediatrics and Adolescent Medicine, Juliane Marie Center, Copenhagen University Hospital "Rigshospitalet", Copenhagen, Denmark.
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMC Health Serv Res. 2020 Dec 10;20(1):1137. doi: 10.1186/s12913-020-05984-y.
Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms.
Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations.
Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen's d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen's d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam.
The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training.
培训是试图提高低收入和中等收入国家医疗服务质量的一种常见且具有成本效益的方式，但缺乏关于将增加的知识成功转化为临床改变的背景因素的研究，尤其是在初级保健领域。本研究的目的是评估背景因素对吉尔吉斯斯坦和越南农村医护人员培训效果的影响，这些培训涉及管理有呼吸道症状的儿科患者的知识和临床表现。
吉尔吉斯斯坦和越南的初级保健卫生工作者参加了为期一天的五岁以下儿童哮喘培训课程。使用经过验证的问卷并通过直接临床观察来衡量培训对知识和临床表现的影响。
81名医护人员参加了培训。在吉尔吉斯斯坦，基线表现较低，他们的知识增加了1.1个科恩d值（置信区间：0.7至1.4）；在越南，知识增加了1.5个科恩d值（置信区间：0.5至2.5）。在吉尔吉斯斯坦，不同类型的医护人员进行了会诊，询问了至少一种呼吸道疾病核心症状的会诊增加了79.1%（置信区间73.9%至84.3%）。在越南，只有医生参与会诊，增加了25.0%（置信区间15.1%至34.9%）。吉尔吉斯斯坦培训后临床检查有显著改善。在越南，执行的操作数量总体上有所下降。背景因素中最明显的差异是会诊时间，吉尔吉斯斯坦的中位数为15分钟，越南为2分钟。
在低收入和中等收入国家对初级保健卫生工作者进行五岁以下儿童哮喘诊断和管理培训对知识的影响，只有在会诊时间允许改变临床实践的情况下才转化为临床表现的改变，这强调了考虑背景因素对于培训后成功实现行为改变的重要性。
