Training Healthcare Professionals to Address Reproductive Health for Persons with Disabilities in Tanzania

培训医疗保健专业人员以解决坦桑尼亚残疾人的生殖健康问题

• 批准号: 10596703
• 负责人: Kristen Patricia Mark
• 金额: $ 75.66万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-05 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596703
• 关键词: Address; Adopted; Africa; Africa South of the Sahara; African; Age; Ally; Attitude; Blinded; Caregivers; Caring; Christianity; Clinic; Communities; Community Health; Consult; Counseling; Country; Development; Disabled Persons; Discipline; Discipline of Nursing; Discrimination; Education; Educational Curriculum; Ensure; Environment; Epidemic; Evaluation; Exclusion; Face; Faculty; Focus Groups; Funding; Future; Government; HIV; Health; Health Personnel; Health Professional; Health Services; Health education; Healthcare; Indigenous; Individual; Intervention Trial; Interview; Knowledge; Language; Learning; Medical Students; Medicine; Midwifery; Modeling; Morbidity - disease rate; Muslim religion; Needs Assessment; Nursing Students; Outcome; Pan American Health Organization; Participant; Patients; Persons; Policies; Population; Pregnancy in Adolescence; Professional Education; Randomized; Randomized, Controlled Trials; Recording of previous events; Religion; Reproductive Health; Research; Research Personnel; Science; Sexual Health; Sexually Transmitted Diseases; Structure; Students; Taboo; Tanzania; Testing; Trainers Training; Training; Training Programs; Tribes; United States National Institutes of Health; Universities; Waiting Lists; Writing; acceptability and feasibility; arm; comparison control; design; disability leave; effectiveness evaluation; efficacy testing; evidence base; experience; follow-up; health care delivery; health communication; health knowledge; health training; high risk; improved; informant; intervention effect; low income country; mortality; neglect; patient population; pilot test; professional students; provider behavior; routine care; secondary analysis; sex; sexual violence; single-blind trial; skill acquisition; skills; social; social stigma; statistics; treatment arm; unintended pregnancy

PROJECT SUMMARY Training of healthcare providers in the reproductive and sexual health (RSH) needs of persons with disabilities (PWD) is critical to addressing a broad array of RSH concerns. Rigorous trials evaluating the effects of curricula on provider behavior are rare. Specifically, we could find no formalized training of healthcare providers in RSH for PWD in sub-Saharan Africa, an environment with the highest rates of human immunodeficiency virus (HIV), sexually transmitted infection (STI), and unintended pregnancy in the world; and where RSH challenges are common and particularly dire for PWD. Reproductive healthcare is a sensitive issue in Africa and PWD are often excluded from consideration. Consequently, a rigorous study of PWD RSH education for healthcare providers is needed if such education is to be widely adopted. Currently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we are conducting a rigorous randomized controlled trial (RCT) of an Afrocentric RSH curriculum training for healthcare providers which was partly adapted from PAHO/WHO for implementation in Tanzania. When we assessed the need for training in RSH needs of PWD in our participants in this trial, nursing, midwifery, and medical students indicated RSH curriculum for PWD to be highly acceptable, needed, and desired by students, and our current NIH-funded RCT has clearly indicated the feasibility of implementation. The next logical step is to create a culturally relevant RSH curriculum to improve student knowledge, attitudes, and skills in providing RSH care for PWD. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of RSH care delivery for PWD in Tanzania. To determine the most important content when accessing RSH care, we will interview ~20 PWD and ~20 PWD caregivers (total of ~40 interviews) on their experience accessing RSH care. To determine the needs from the perspective of the healthcare workers, we will conduct focus groups of midwifery, nursing, and medical students (3 from each discipline). We will also conduct individual interviews with 12 key informants. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an Afrocentric, culturally appropriate RSH curriculum for health providers focused on caring for PWD. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on RSH for PWD knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test efficacy of the curriculum. We will consult an advisory board of PWD in Tanzania to address structural and cultural issues throughout and use Universal Design (UD)/Universal Design for Learning (UDL) consultant for all study materials. If effective, MUHAS has committed to implement the curriculum for all health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

项目总结 对保健提供者进行有关残疾人生殖和性健康(RSH)需求的培训 (PWD)对于解决广泛的RSH问题至关重要。严格的试验评估的效果 有关供应商行为的课程很少。具体地说，我们找不到正规的医疗保健培训 在撒哈拉以南非洲为残疾患者提供RSH的提供者，这是一个人类发病率最高的环境 世界上免疫缺陷病毒(艾滋病毒)、性传播感染(STI)和意外怀孕； 在那里，RSH挑战是常见的，对于PWD来说尤其可怕。生殖保健是一个敏感的问题 在非洲，残疾人和残疾人往往被排除在考虑之外。因此，对PWD RSH的严格研究 如果要广泛采用这种教育，就需要对医疗保健提供者进行教育。目前，在穆亨比利 在达累斯萨拉姆的健康与联合科学大学(MUHAS)，我们正在进行一项严格的随机 针对医疗保健提供者的非中心RSH课程培训的对照试验(RCT)，部分是 改编自泛美卫生组织/世卫组织，以便在坦桑尼亚实施。当我们评估RSH培训的必要性时 本试验的受试者、护理、助产和医科学生对PWD的需求显示RSH 残障人士的课程是学生高度接受、需要和期望的，我们目前由NIH资助 区域合作研究已经明确表明了实施的可行性。下一个合乎逻辑的步骤是创建一个文化上的 相关的RSH课程，以提高学生在为残障人士提供RSH护理方面的知识、态度和技能。 有三个具体目标。目标1是对RSH护理服务的社会生态需求进行评估 为坦桑尼亚的残障人士服务。为了确定访问RSH CARE时最重要的内容，我们将采访 约20名PWD和约20名PWD照顾者(总共采访了~40次)，了解他们获得RSH护理的经验。至 从医护人员的角度确定需求，我们将开展以下重点小组 助产学、护理学和医学系学生(每个学科各3名)。我们还将进行个别采访。 有12个关键线人。在目标2中，我们将进一步调整我们的课程，确保它在文化上适合 坦桑尼亚/撒哈拉以南地区的情况，并进行试点测试。目标3是评估非中心化的有效性， 在文化上适合的RSH课程，主要针对关注残障的健康提供者。我们将进行一项 随机对照单盲对照试验评估RSH对RSH的影响 学习残疾知识、态度和咨询技能(每个手臂206名学生，共412名)。假说将 测试课程的效能。我们将咨询坦桑尼亚残疾人发展顾问委员会的意见，以解决结构和 文化问题贯穿始终，并使用通用设计(UD)/通用学习设计(UDL)顾问 所有的学习材料。如果有效，MUHAS已承诺为所有健康学生实施该课程。 鉴于MUHAS在整个非洲的卫生学生教育中是卓越的，本研究评估的课程 有很大潜力被广泛采用，作为非洲各地卫生专业人员培训的新标准。