National Institute of Public Health (INSP), Division of Health Economics and Health Systems Innovations, Cuernavaca, Mexico.
School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.
PLoS One. 2021 Dec 2;16(12):e0260571. doi: 10.1371/journal.pone.0260571. eCollection 2021.
Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics.
We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility.
The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels.
HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.
在资源匮乏的环境中，寻找提高医疗服务提供者知识水平的方法至关重要。本研究评估了肯尼亚、卢旺达、南非和赞比亚医疗机构中 HIV 检测咨询（HTC）、预防母婴传播（PMTCT）和男性自愿性医学环切术（VMMC）等方面的提供者知识水平，并探讨了 HTC、PMTCT 和 VMMC 提供者知识水平与提供者和医疗机构特征之间的关系。
我们使用 2012 年和 2013 年收集的数据。在肯尼亚（66 个）、卢旺达（67 个）、南非（57 个）和赞比亚（58 个）的医疗机构中，向医生、护士和咨询员发放了情景模拟题。分析样本包括 HTC（755 人）、PMTCT（709 人）和 VMMC（332 人）的提供者。使用项目反应理论（IRT）构建 HTC、PMTCT 和 VMMC 提供者知识得分。使用广义线性回归（GLM）模型分析提供者知识与提供者和医疗机构特征之间的关联，重点关注平均患者量、提供者岗位工作年限、在其他机构工作的提供者、机构中的高级职员、项目开展年限、干预措施专职人员比例、机构内人员培训天数和管理评分。我们构建了三个模型：模型 1 未进行聚类的标准误估计，模型 2 进行稳健标准误估计，模型 3 进行基于机构的聚类标准误估计。
在所有三种干预措施中，平均知识得分均为 36 分。在模型 1 中，我们发现具有高级职员的机构和干预措施专职人员比例较高的机构的提供者知识得分更高。我们还发现，与结果呈负相关的因素包括提供者岗位工作年限、平均项目开展年限、在其他机构工作的提供者、人员培训天数和管理评分。在模型 3 中，仅提供者岗位工作年限、平均项目开展年限和管理评分的系数在常规水平上仍具有统计学意义。
肯尼亚、卢旺达、南非和赞比亚的 HTC、PMTCT 和 VMMC 提供者知识水平较低。本研究表明，不可观察的组织因素可能有助于沟通、学习和知识获取。一方面，我们的研究表明，高级职员的存在和员工的敬业精神可能会促进知识的获取。另一方面，我们的研究提醒人们注意与员工在岗位上的工作时间和项目开展年限相关的知识折旧风险。
