The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
BMC Public Health. 2021 Mar 16;21(1):508. doi: 10.1186/s12889-021-10483-8.
Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model.
The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants' assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method.
The findings identified the following barriers to child-participation: Primary caregiver limiting the child's involvement due to fear of traumatising them; HCWs' limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs' and PCGs' fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care.
This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings.
南非的医疗工作者（HCWs）广泛使用工作辅助工具作为实用工具，以增强提供艾滋病毒服务的能力，从而改善护理过程中的医患互动。工作辅助工具是一种视觉支持材料，它以简单而有效的方式使用图形和文字提供适当的信息。我们通过 KidzAlive Talk 工具故事书（Talk 工具）探索了这一机制，这是一种以儿童为中心的工作辅助工具，用于在实施 KidzAlive 模式的初级保健（PHC）诊所中促进 HCWs 在艾滋病毒咨询过程中让儿童参与。
该研究在南非夸祖鲁-纳塔尔省（KwaZulu-Natal，KZN）的四个地区的 PHC 诊所进行：乌姆坎夸德、祖鲁兰、乌姆古农多卢和埃特肯尼。我们对儿童（n=30）、他们的主要照顾者（PCG）（n=30）和受过 KidzAlive 培训和指导的 HCWs（n=20）进行了深入访谈。数据分别以英语和祖鲁语通过特定于用户的、结构化的深入访谈收集。所有访谈均获得了参与者的同意和同意，并分别进行了录音。在将祖鲁语转录翻译成英语之前，对访谈内容进行了逐字记录。翻译由一名精通两种语言的研究团队成员完成。电子数据被导入 NVivo 10 进行分析，然后使用主题分析方法进行分析，随后使用恒定比较和改进的扎根理论分析方法进行分析。
研究结果确定了以下阻碍儿童参与的障碍：主要照顾者因担心对孩子造成创伤而限制孩子的参与；HCWs 提供以儿童为中心的艾滋病毒护理的知识和技能有限；与儿童发展阶段相关的限制和医疗保健机构的家长式作风。Talk 工具通过使用简单的语言和术语来满足各个发展阶段的儿童的需求；减轻 HCWs 和 PCG 对孩子可能遭受心理伤害的恐惧；使用讲故事和丰富多彩的卡通插图进行儿童教育；通过允许多种用途和解决限制儿童参与护理过程的机构家长式作风来提高多功能性。
本研究提供了关于 Talk 工具故事书如何解决艾滋病毒护理过程中儿童参与障碍的证据。这项研究产生的证据足以强烈建议在资源匮乏的环境中扩大这一创新。
