A total facility approach to reducing HIV stigma in health facilities: implementation process and lessons learned
A total facility approach to reducing HIV stigma in health facilities: implementation process and lessons learned
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DOI：
10.1097/qad.0000000000002585
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发表时间：
2020-09-01
期刊：
影响因子：
3.8
通讯作者：
Kraemer, John D.
中科院分区：
文献类型：
--
作者：
Nyblade, Laura;Mbuya-Brown, Rebecca J.;Kraemer, John D.
目的：描述开发和实施一个三阶段的“总设施”的方法，以减少卫生设施艾滋病毒的耻辱在加纳和坦桑尼亚，以促进replication.Design：艾滋病毒的耻辱在医疗环境中阻碍了艾滋病毒的反应，并可能发生在客户端和工作人员之间的任何互动，工作人员之间，机构的流程和结构内。因此，设计重点关注卫生机构内的多个社会生态层面，并针对各级工作人员（临床和非临床）。该方法以社会认知理论原则和人际或群体间接触理论为基础，旨在通过创造人际互动空间，培养同情心，并通过意识，技能，和知识建设，以及通过联合行动规划设施环境所需的变化。该方法针对卫生设施工作人员之间的耻辱可采取行动的驱动程序：艾滋病毒传播的恐惧，认识的耻辱，态度，和卫生设施environment.Results：结果是形成性研究，能力建设，并融入设施结构和流程的三个阶段的过程。在执行工作中汲取的主要经验教训包括：形成性数据对于促进行动和形成干预活动的重要性;采用参与式培训方法;让设施管理层参与整个培训过程;让工作人员和艾滋病毒感染者为培训提供便利;让相当一部分工作人员参与培训;将工作人员干部和各部门混合到培训小组中;以及将减少耻辱感纳入现有结构和进程。解决卫生设施中的污名问题至关重要，这一办法提供了一种可行的、广为接受的方法。版权所有（C）2020作者。由Wolters Kluwer Health，Inc.出版。
Objectives: To describe development and implementation of a three-stage 'total facility' approach to reducing health facility HIV stigma in Ghana and Tanzania, to facilitate replication.Design: HIV stigma in healthcare settings hinders the HIV response and can occur during any interaction between client and staff, between staff, and within institutional processes and structures. Therefore, the design focuses on multiple socio-ecological levels within a health facility and targets all levels of staff (clinical and nonclinical).Methods: The approach is grounded in social cognitive theory principles and interpersonal or intergroup contact theory that works to combat stigma by creating space for interpersonal interactions, fostering empathy, and building efficacy for stigma reduction through awareness, skills, and knowledge building as well as through joint action planning for changes needed in the facility environment. The approach targets actionable drivers of stigma among health facility staff: fear of HIV transmission, awareness of stigma, attitudes, and health facility environment.Results: The results are the three-stage process of formative research, capacity building, and integration into facility structures and processes. Key implementation lessons learned included the importance of formative data to catalyze action and shape intervention activities, using participatory training methodologies, involving facility management throughout, having staff, and clients living with HIV facilitate trainings, involving a substantial proportion of staff, mixing staff cadres and departments in training groups, and integrating stigma-reduction into existing structures and processes.Conclusion: Addressing stigma in health facilities is critical and this approach offers a feasible, well accepted method of doing so. Copyright (C) 2020 The Author(s). Published by Wolters Kluwer Health, Inc.