Background
Methods
Phase 1: pre-training baseline survey
Phase 2: the intervention
Phase 3: post training evaluation
Data analysis
Results
Socio-demographic characteristics of HCPs
Parameter | Frequency, n (%) |
---|---|
Age (years) | |
< 30 | 5 (17.9) |
30–40 | 13 (46.4) |
41–50 | 8 (28.6) |
51–60 | 2 (7.1) |
Gender | |
Male | 6 (21.4} |
Female | 22 (78.6) |
Category of staff | |
Nurse/Midwife | 19 (67.9) |
Doctor | 1 (3.6) |
Biomedical scientist | 4 (14.3) |
Support staffa | 4 (14.3) |
Years in healthcare | |
< 5 | 7 (25.0) |
5–10 | 9 (32.1) |
10–15 | 8 (28.6) |
15–20 | 3 (10.7) |
> 20 | 1 (3.6) |
Current Unit in the hospital | |
Public health unit/ART Clinic | 18 (64.3) |
Laboratory | 4 (14.3) |
TB UNIT | 2 (7.1) |
Wards | 4 (14.3) |
Years at the current unit in the hospital | |
< 5 | 13 (46.4) |
5–10 | 12 (42.9) |
10–15 | 2 (7.1) |
15–20 | 0 (0.0) |
> 20 | 1 (3.6) |
Are you a trained HIV counselor? | |
Yes | 23 (82.1) |
No | 5 (17.9) |
How/Where did you receive training in HIV counseling? (N = 23) | |
On the job by my colleagues | 8 (34.8) |
By the National AIDS Control Programme | 11 (47.8) |
As part of my professional training program | 4 (17.4) |
Knowledge of HCPs on general adolescent health, education and counseling
Parameter | Frequency, n (%) |
---|---|
Do you consider yourself knowledgeable about adolescent health issues? | |
Yes | 21 (75.0) |
No | 7 (25.0) |
What is the correct definition for adolescents? | |
Persons aged 10–19 years | 10 (35.7) |
Persons aged 13–19 years | 18 (64.3) |
Have you received any formal training on adolescent health? | |
Yes | 14 (50.0) |
No | 14 (50.0) |
Have you received any training on how to work with the adolescent client? | |
Yes | 10 (35.7) |
No | 18 (64.3) |
Does the adolescent have the right to privacy? | |
Yes | 26 (92.8) |
No | 1 (3.6) |
I do not know | 1 (3.6) |
Does the adolescent have the right to informed consent? | |
Yes | 24 (85.7) |
No | 2 (7.1) |
I do not know | 2 (7.1) |
Are all adolescents the same in terms of characteristics and behavior? | |
Yes | 5 (17.9) |
No | 20 (71.4) |
I do not know | 3 (10.7) |
Are you aware of any Laws and Policies related to Adolescents in Ghana? | |
Yes | 19 (67.9) |
No | 5 (17.9) |
I do not know | 4 (14.2) |
Are counseling approaches/techniques used in the general adolescent health the same as those used for ALHIV? | |
Yes | 11 (39.3) |
No | 12 (42.8) |
I do not know | 5 (17.9) |
Which of these is an adolescent health assessment tool? | |
WHODAS | 1 (3.6) |
HEADSSS | 3 (10.7) |
WHOQAS | 0 (0.0) |
ADOLETS | 2 (7.1) |
No idea | 22 (78.6) |
Post training knowledge
“It [adolescent friendly services] must be accessible to all, in terms of location. It should be situated in a place that is not too open or too far from access to transport. There should be directional signs to guide. It should not be expensive too. Services provided must be appropriate to the developmental and health needs of the adolescent. Services must be acceptable to the adolescent.” (P010, Male HTC Counselor).
"It is a very good tool because it covers all aspects of adolescent life and helps in knowing whether the adolescent is at risk of a particular health problem or not" (P001, HTC/Adherence counselor)
The perceived improved knowledge and competence in the psychosocial assessment is heightened in participants’ readiness and ability to use the HEADSSS tool for routine assessment of ALHIV, which was very reassuring."I was first introduced to the tool during the training. It is a good tool and very useful. This is because it will enable us to perform a comprehensive assessment of the adolescent client quickly and to identify any threat to their physical, psychological or social life." (P005, Female HTC/TB Drug Adherence Counselor)
“I am ready to use the tool but will need the manual or a checklist as a guide.” (P005, Female HTC/TB Drug Adherence Counselor)
I have started using the tool. At first, it appears to be lengthy, but with time when one gets used to the set of questions, I believe the time spent will be shortened. A checklist of the abridged version will be very much appreciated." (P007, Female HTC/ART Adherence Counsellor)
HCPs practices regarding adolescents counseling and other care provision
Parameter | Frequency, n (%) |
---|---|
How often do you seek the consent of adolescents in all care related activities? | |
Always | 10 (35.7) |
Most of the times | 4 (14.3) |
Sometimes | 10 (35.7) |
Never | 4 (14.3) |
How often do you seek the consent of adolescents if personal health information is to be disclosed outside the health care team? | |
Always | 8 (28.6) |
Most of the times | 4 (14.3) |
Sometimes | 9 (32.1) |
Never | 7 (25.0) |
Who have you ever shared an adolescents’ health information with? | |
Other health care team members | 10 (35.7) |
Parents/guardians | 6 (21.4) |
School teacher | 0 (0.0) |
I have never | 12 (42.9) |
How often do you discuss ALHIV information with colleague HWCs? | |
Always | 1 (3.5) |
Most of the times | 2 (7.1) |
Sometimes | 16 (57.1) |
Never | 9 (32.1) |
Does the adolescent have the right to make healthy choices for him/herself? | |
Yes | 24 (85.7) |
No | 1 (3.5) |
I do not know | 3 (10.7) |
Will you deny the adolescent of a service that is his/her health choice, if you think such a healthy choice will harm him/her? | |
Yes | 17 (60.6) |
No | 2 (7.1) |
Not sure | 9 (32.1) |
Do you inform adolescents of their diagnosis, the treatment process, and prognosis in the presence of their guardians? | |
Always | 5 (17.9) |
Most of the times | 6 (21.4) |
Sometimes | 11 (39.2) |
Never | 6 (21.4) |
How often do you ask about the psycho-social needs of ALHIV that you see during clinic hours? | |
Always | 5 (17.9) |
Most of the times | 9 (32.1) |
Sometimes | 9 (32.1) |
Rarely | 5 (17.9) |
How often do you carry out health education for adolescent clients? | |
First time I meet an adolescent client | 1 (3.5) |
Every time I meet adolescent clients | 10 (35.7) |
Occasionally, depending on their needs | 10 (35.7) |
Occasionally depending on the workload at the clinic | 4 (14.3) |
Rarely | 3 (10.7) |
Does your facility have protocol/guidelines for general adolescent counseling? | |
Yes | 13 (46.4) |
No | 7 (25.0) |
I do not know | 8 (28.6) |
Are the available counseling guidelines in your facility clear or specific on how to counsel an ALHIV? | |
Yes | 4 (14.3) |
No | 13 (46.4) |
I do not know | 11 (39.2) |
Post training practices
“There should be a holistic approach to care and need to factor in their growth and developmental needs. Every encounter with them is an opportunity for health communication. We need to adhere to national adolescent health policy, such as issues of when to maintain confidentiality or the type of care the HCW can give to the adolescent with or without parental consent” (P006, Female HTC/ART Adherence Counsellor/ Adolescence Health Focal Person)
Perception/attitude of HCPs towards working with adolescents
Parameter | Frequency, n (%) |
---|---|
I have what it takes to work with adolescents | |
Disagree | 7 (25.0) |
Neutral | 0 (00.0) |
Strongly Agree | 21 (75.0) |
Working with adolescents can be very challenging | |
Disagree | 2 (7.1) |
Neutral | 0 (0.0) |
Agree | 26 (92.9) |
Working with adolescents can be fun | |
Disagree | 6 (21.4) |
Neutral | 2 (7.1) |
Agree | 22 (78.5) |
How ready are you to accept calls from your adolescent clients at any time in the day? | |
Not ready | 1 (3.5) |
A little ready | 4 (14.3) |
Ready | 11 (39.3) |
Very ready | 12 (42.9) |
How committed are you to adolescent health-related activities | |
Very committed | 16 (57.1) |
Somehow committed | 9 (32.1) |
Not committed | 3 (10.7) |
How worried are you about adolescent becoming dependent on you because of your caring nature | |
Not worried | 6 (21.4) |
A little worried | 15 (53.6) |
Very worried | 7 (25.0) |
HCPs who have received training in adolescent health counseling are more likely to provide quality care | |
Disagree | 7 (25.0) |
Neutral | 0 (00.0) |
Agree | 21 (75.0) |
HCPs who have not received training in adolescent health counseling are more likely to have difficulties working with adolescents | |
Disagree | 5 (17.9) |
Neutral | 2 (7.1) |
Agree | 21 (75.0) |
For every decision to be taken regarding an adolescent’s health, the parents/guardians must know, so long as he/she is a minor | |
Disagree | 8 (28.6) |
Neutral | 4 (14.3) |
Agree | 16 (57.2) |
Because of the workload at the clinic, it is very difficult to have one on one quality time engaging adolescent clients in discussing their health | |
Disagree | 4 (14.3) |
Neutral | 4 (14.3) |
Agree | 20 (71.4) |
Because of their peculiar issues/challenges, it is always better to have a separate healthcare facility/unit for only adolescents | |
Disagree | 3 (10.7) |
Neutral | 4 (14.3) |
Agree | 21 (75.0) |
A checklist on psychosocial assessment to be administered routinely would help track their needs | |
Disagree | 2 (7.1) |
Neutral | 2 (7.1) |
Agree | 24 (85.7) |
Specific HCPs should be assigned only to attend to the needs of ALHIV at the facility to facilitate quality care | |
Disagree | 6 (21.4) |
Neutral | 0 (00.0) |
Strongly Agree | 22 (78.6) |
Post-training perception/attitude
"I can now confidently work at the ALHIV clinic. Because I have gained new knowledge on how to probe for more information that will form the basis to provide needed and quality care to them. I am ready to put to practice all that I have learned. However, it will be better if we are provided with a manual to guide us." (P009, Female HTC/ART Adherence Counsellor)
“Yes, I now have what it takes to care for my ALHIV clients. This is because I can now apply the concepts and strategies taught and also use the new assessment tool as a guide when dealing with them.” (P008, Female Dietician/Diet therapy Counsellor)
“Yes, to a greater extent. I can communicate with them better. I will also apply the various strategies and skills when caring for them. I can also better assess my adolescent client with the HEADSSS tool. I have had a better understanding of what the adolescent health policy says especially about adolescent confidentiality and decisions they are entitled, so I now know where to draw the line.” (P001, Male HTC/Adherence Counselor).
“Our facility lack manuals for ALHIV care to guide HCWs, as well as educational materials and other recreational activities for ALHIV especially during waiting. We have serious issues with space. Our setting is not helping us to provide a more comprehensive and quality care to our clients. We, therefore, need help from NACP and other stakeholders, for a friendlier adolescent site to support our adolescent have a better life.” (P001, Male HTC/Adherence Counselor)