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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要对医疗保健提供者进行关于残疾人生殖和性健康 (RSH) 需求的培训 (PWD) 对于解决一系列广泛的 RSH 问题至关重要。严格的试验评估效果关于提供者行为的课程很少。具体来说，我们找不到正规的医疗保健培训撒哈拉以南非洲地区是人类死亡率最高的地区，为残疾人提供 RSH 服务世界范围内的免疫缺陷病毒（HIV）、性传播感染（STI）和意外怀孕；和 RSH 挑战很常见，对于残疾人来说尤其严峻。生殖保健是一个敏感问题在非洲，残疾人和残疾人常常被排除在考虑之外。因此，对 PWD RSH 进行了严格的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，在穆辛比利在达累斯萨拉姆健康与联合科学大学 (MUHAS)，我们正在进行严格的随机研究针对医疗保健提供者的以非洲为中心的 RSH 课程培训的对照试验 (RCT)，部分是改编自泛美卫生组织/世界卫生组织，供坦桑尼亚实施。当我们评估 RSH 培训的必要性时 RSH 表示，本次试验的参与者、护理人员、助产士和医学生对残疾人士的需求残疾人士课程高度被学生接受、需要和渴望，以及我们目前由 NIH 资助的 RCT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相关 RSH 课程，以提高学生为残疾人提供 RSH 护理的知识、态度和技能。具体目标有三个。目标 1 是对 RSH 护理服务进行社会生态需求评估坦桑尼亚的残疾人。为了确定获得 RSH 护理时最重要的内容，我们将进行访谈约 20 名残疾人和约 20 名残疾人护理人员（总共约 40 次访谈）谈论他们获得 RSH 护理的经历。到从医护人员的角度确定需求，我们将开展焦点小组助产学、护理学和医学生（每个学科 3 名）。我们还将进行个别采访有 12 名关键线人。在目标 2 中，我们将进一步调整我们的课程，确保其在文化上适合坦桑尼亚/撒哈拉以南地区的背景，并对其进行试点测试。目标 3 是评估非洲中心的有效性，适合侧重于残疾人护理的卫生服务提供者的符合文化的 RSH 课程。我们将进行一次对照候补名单对照评估对 RSH 的影响，对课程进行随机、对照、单盲试验残疾人知识、态度和咨询技能（每组 206 名学生；总共 412 名）。假设将测试课程的有效性。我们将咨询坦桑尼亚 PWD 的咨询委员会，以解决结构性和文化问题贯穿始终，并使用通用设计（UD）/通用学习设计（UDL）顾问所有学习材料。如果有效，MUHAS 承诺为所有健康专业的学生实施该课程。鉴于 MUHAS 在整个非洲的健康学生教育领域表现出色，本研究评估的课程具有被广泛采用作为非洲卫生专业人员培训新标准的巨大潜力。