Evaluation of lay health workers' needs to effectively support anti-tuberculosis treatment adherence in Malawi
DESIGN: Qualitative study utilizing focus groups and interviews conducted with LHWs providing tuberculosis (TB) care in Zomba District, Malawi.
RESULTS: Participants identified lack of knowledge, both general (understanding of TB and its treatment) and job-specific (understanding of tasks such as completion of treatment forms), as the key barrier to LHWs in their role as adherence supporters. Lack of knowledge among LHWs providing TB care was reported to lead to a lack of confidence, conflicting messages given to patients, poor interactions with patients and errors in documentation. In addition to lack of knowledge, a number of system barriers were identified as limiting LHWs' ability to function optimally, including a lack of physical resources, workload, communication delays and ineffective guardians.
CONCLUSION: Our findings suggest a gap between LHW knowledge and their responsibilities as adherence supporters. The results have informed the development of an educational outreach intervention and point-of-care tool, to be evaluated in a randomized trial in Zomba District.
Keywords: adherence; barriers; default; facilitators; qualitative methods
Document Type: Research Article
Affiliations: 1: University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada 2: Dignitas International, Zomba, Malawi; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 3: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada 4: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Dignitas International, Toronto, Ontario, Canada 5: Ministry of Health Malawi, Lilongwe, Malawi 6: Dignitas International, Toronto, Ontario, Canada; George Institute for Global Health, Sydney, New South Wales, Australia; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; The University of Sydney, Sydney, New South Wales, Australia 7: Dignitas International, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada 8: Dignitas International, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Knowledge Translation Unit, Lung Institute, University of Cape Town, Cape Town, South Africa; Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
Publication date: 01 November 2012
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