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

项目摘要 对医疗服务提供者进行残疾人生殖健康和性健康需求方面的培训 (PWD)对于解决广泛的RSH问题至关重要。严格的试验评估的影响 关于供应商行为的课程很少。具体来说，我们找不到正规的医疗保健培训， 在撒哈拉以南非洲地区，RSH为PWD提供者，人类死亡率最高的环境 免疫缺陷病毒（HIV）、性传播感染（STI）和意外怀孕;以及 在这些地区，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问题 在非洲，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，就需要对保健提供者进行教育。目前，在Muhimbili 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 对照试验（RCT）的非洲中心RSH课程培训的医疗保健提供者，这是部分 改编自泛美卫生组织/世卫组织，以在坦桑尼亚实施。当我们评估RSH培训的需求时， 本试验中，我们的参与者、护士、助产士和医学生的PWD需求表明RSH PWD课程是高度可接受的，需要的，学生想要的，我们目前的NIH资助 RCT明确指出了实施的可行性。下一个合乎逻辑的步骤是创造一个文化上的 相关的生殖健康和安全课程，以提高学生在为残疾人提供生殖健康和安全护理方面的知识、态度和技能。 有三个具体目标。目标1是对RSH护理提供进行社会生态需求评估 坦桑尼亚的残疾人项目为了确定获得RSH护理时最重要的内容，我们将采访 约20名残疾人和约20名残疾人护理人员（共约40次访谈）关于他们获得RSH护理的经验。到 从医护人员的角度来决定需要，我们会进行 助产学、护理学和医学专业学生（每个学科3名）。我们也会进行个别访谈 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 目标3是评估以非洲为中心， 为保健提供者提供文化上适当的生殖健康和安全课程，重点是照顾残疾人。我们将进行 随机、对照、单盲试验，评估对RSH的影响 PWD知识，态度和咨询技能（每组n=206名学生;共412人）。假设将 测试课程的有效性。我们将咨询坦桑尼亚残疾人咨询委员会， 文化问题，并使用通用设计（UD）/通用设计学习（UDL）顾问， 所有学习材料。如果有效，MUHAS承诺为所有卫生专业学生实施课程。 鉴于MUHAS在整个非洲的卫生学生教育方面是卓越的，本研究评估的课程 它很有可能被广泛采用，成为非洲卫生专业人员培训的新标准。

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.