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Indian Journal of Community Medicine

Impact of training, on perceptions and practices related to human immunodeficiency virus/acquired immunodeficiency syndrome, on male health workers in Rajkot district, Gujarat

Author(s): Katira JM, Dutt D, Tolia PB, Chatterjee P

Vol. 32, No. 2 (2007-04 - 2007-06)

SHORT ARTICLE

Year : 2007 | Volume : 32 | Issue : 2 | Page : 128-130

Impact of training, on perceptions and practices related to human immunodeficiency virus/acquired immunodeficiency syndrome, on male health workers in Rajkot district, Gujarat

Katira JM1, Dutt D1, Tolia PB2, Chatterjee P1
1 Department of Public Health Administration, All India Institute of Hygiene and Public Health, Chittaranjan Avenue, Kolkata, India
2 Regional Deputy Director's Office Rajkot, Gujarat, India
Date of Submission 08-Oct-2004

Correspondence Address:
Dutt D
Department of Public Health Administration, All India Institute of Hygiene and Public Health, 110, Chittaranjan Avenue, Kolkatta - 700 073, West Bengal
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Katira JM, Dutt D, Tolia PB, Chatterjee P. Impact of training, on perceptions and practices related to human immunodeficiency virus/acquired immunodeficiency syndrome, on male health workers in Rajkot district, Gujarat. Indian J Community Med 2007;32:128-30
How to cite this URL:
Katira JM, Dutt D, Tolia PB, Chatterjee P. Impact of training, on perceptions and practices related to human immunodeficiency virus/acquired immunodeficiency syndrome, on male health workers in Rajkot district, Gujarat. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:128-30. Available from: http://www.ijcm.org.in/text.asp?2007/32/2/128/35651

Since 1986, when the first acquired immunodeficiency syndrome (AIDS) patient was detected in India, the AIDS epidemic has grown steadily. The spread of the epidemic depends on a myriad of factors-personal, social, economic, cultural, and other intricately related factors. Health workers have an important role in influencing the spread and the impact of the epidemic. It has been observed that the perceptions regarding human immunodeficiency virus (HIV)/AIDS among the health workers are not consistent, and there exists many misconceptions with regard to HIV/AIDS. [1],[2],[3],[4] Many health workers are not willing to provide the necessary care and services [5] to the HIV/AIDS infected patients. Health worker males (HWMs) and females (HWFs) provide the first level care in the public health sector, and therefore, it is essential to train these workers to create a positive attitude toward the HIV/AIDS patient. This study was conducted to (1) identify the training needs of HWMs with respect to HIV/AIDS, (2) provide the required training with regard to HIV/AIDS, and (3) to evaluate the impact of training on HWMS with regard to their perceptions and behavior toward HIV/AIDS.

Materials and Methods

The study was conducted in the Rajkot district of Gujarat from October 2001 to April 2002. A total of 135 HWMs of the district were eligible for the study. The training needs of the HWMs were assessed. Information regarding the educational background, service hours, previous training received on HIV/AIDS, and current perceptions regarding HIV/AIDS was collected. Based on the findings, it was revealed that the HWMs had undergone training on HIV/AIDS. Two months after the training, a test was conducted to assess the changes, if any, with regard to their perception and behavior toward HIV/AIDS. The data were collected using a self-administered questionnaire.

The questionnaire included sections on knowledge, attitude, and practice toward HIV/AIDS. The Z-test was performed for testing statistical significance and a P -value of <0.05 was considered statistically significant.

Results

Of the 135 HWMs present in Rajkot district, 115 (85.2%) participated in the study. The mean age of the HWMs was 41.1 years (SD 9.7 years). Of the 115 HWMs, 110 (95.7%) had attended at least one training program on HIV/AIDS in the last five years.

Prior to the training, only 23.5% of the HWMs were aware of the fact that HIV/AIDS was caused by a virus [Table - 1]. Post training, 87.8% of the HWMs acquired this knowledge ( P < 0.01). Prior to the training, only 61.7% were aware that HIV was a life-long infection, and 60.8% were aware that no vaccines were currently available for HIV. Post-training, 90.4% and 87% of HWMs showed improvement with regard to these facts, respectively ( P < 0.01). With regard to transmission of HIV infection, most of the HWMs were aware that the infection was transmitted through sex and by using unsterile needles and syringes. However, 83.5% assumed that the infection could also be transmitted through mosquito bites, and 16.6% were not certain if casual kissing would transmit HIV. Post-training, 85.3% and 96.6%, respectively, learnt that mosquito bites and casual kissing would not transmit HIV infection; a significant ( P < 0.01) improvement was observed in these HWMs with respect to the above facts. The training also imparted knowledge on other aspects of HIV/AIDS; the HWMs that were aware of the fact that the carriers of HIV may not show symptoms increased from 43.5% to 55.7% ( P < 0.05) and those that were aware of the fact that condoms can help reduce the risk of transmission of HIV increased from 95.6% to 100%.

The training improved the attitude of HWMs toward the individuals infected with HIV/AIDS. The HWMs that were of the opinion that the HIV-infected workers should be dismissed from work decreased from 44.4% to 20.9% ( P < 0.01). The HWMs who believed in maintaining the confidentiality about the HIV status of the infected increased from 64.3% to 72.3%. The HWMs willing to provide midwifery services to HIV-positive pregnant women increased from 65.2% to 97.4% ( P < 0.01) and that to maintain friendship with AIDS infected persons increased from 91.4% to 99.1% [Table - 2].

Post training, the percentage of HWMs using sterile needles increased from 93.8% to 97.4%, (HWMs using disposable needles increased from 21.4% to 78.6%, and those using reusable needles increased from 27.3% to 72.2%). The HWMs using hypochlorite solution for disinfection increased from 13.9% to 23.5% ( P < 0.05). A marked improvement was observed with respect to hand-washing among HWMs (it increased from 59.1% (pre-training) to 77.4% (post-training), ( P <0.01)). It was also observed that 82.6% (post-training) of HWMs took precautions while handling body fluids as compared to 60.9% (pre-training) ( P < 0.01).

Discussion

Prior to the training program, only 27% of the HWMs were aware that HIV infection is caused by a retrovirus. In a study conducted among nursing staff in Nagpur, 69% of the respondents were aware that HIV/AIDS was caused by a virus. In our study, 56.5% of the workers were not aware about the asymptomatic stage in HIV infection. Similarly, in other studies[2],[3] a substantial proportion of the health workers (34%-50%) were unaware of the asymptomatic stage in HIV infection. Although, after the training program, a significant amount of improvement with regard to the facts of HIV was observed in 55.7% of HWMs as compared to 43.5% HWMs (pre-training), more than one-third of the workers (33.7%) still responded incorrectly. This indicates that the training material or methodology was unclear and requires modification. The misconception that HIV infection is self-limiting existed among 17% of HWMs, and 26% assumed that an effective vaccine against HIV existed. Such misconceptions can create a serious barrier against effective counseling and lead to the flow of inaccurate information with regard to HIV/AIDS in the community. After the training program, these misconceptions reduced considerably; however, 12.1% of the workers still remained incognizant about the vaccines and treatment against HIV/AIDS. However, 83.5% assumed that the infection could be transmitted through mosquito bites, and 16.6% were not certain if casual kissing would transmit HIV. In a study conducted by Goel,[1] 17.1% of the nursing staff assumed that HIV could be transmitted through casual contact, while 12% of the staff assumed that mosquito bites could transmit HIV infection. In the study conducted by Siddhiqui, [3] 34%, 36%, 90%, and 84% of the subjects assumed that HIV could be transmitted by touching an AIDS patient, sharing cups with an HIV patient, by insect bites, and sharing clothes, respectively.

Adelikan [5] observed that about one-third of the nurses would hesitate to serve patients with HIV/AIDS, while half of them refused to provide midwifery services to HIV/AIDS infected women. In our study, comparatively better attitude was present since 65.2% of the workers were willing to provide midwifery services and this further increased to 97.4% after the training.

In clinical care settings, it has been observed that health personnel do not take appropriate precautionary measures.[4] In our study, only 59.1% washed hands regularly and only 60.9% took precautions while handling blood or body fluids. After the training, there was a considerable increase in these precautionary practices among the health workers; similar results have been found elsewhere.[1],[3]

Most (95.7%) of the HWM in this study had attended a training program on HIV/AIDS at least once in the last five years. While assessing the training needs of the HWMs, it was surprising that misconceptions still existed among the workers despite that fact that they had attended a training program previously. Further, in this study, it was observed that even after providing the required training, some misconceptions, although reduced, still persisted. This indicates the need for repeated training and continuous education to change the perceptions and practices of the health workers toward HIV/AIDS. Additionally, better training programs need to be planned with clearly defined objectives, messages, and appropriate methodologies to improve their effectiveness.

References

1. Goel NK. An explorative KABP study on AIDS among nursing professionals. Indian J Prev Soc Med 1999;30:79-83.
2. Brachman P Jr, Kozarsky P, Cetron M, Jacob MS, Boonitt B, Wongsrichanalai J, et al . Knowledge and attitudes of hospital-based physicians and trainees about HIV infection in the United States, Canada, India, and Thailand. Arch Intern Med 1996;156:761-6. [PUBMED]
3. Siddiqi S, Majeed SA, Saeed Khan M. Knowledge, attitude and practice survey of acquired immune deficiency syndrome (AIDS) among paramedicals in a tertiary care hospital in Pakistan. J Pak Med Assoc 1995;45:200-2. [PUBMED]
4. Mallik JS, Gour DR. A study regarding AIDS awareness among paramedical personnel. Indian J Prev Soc Med 1992;23:141-4.
5. Adelikan ML. A study on KAP of health care provider in Nigeria. AIDS Care 1995;7:63-72.

Tables

Please click on image for larger view

Table 1: Knowledge about human immunodefi ciency virus/acquired immunodefi ciency syndrome

Table 1: Knowledge about human immunodefi ciency virus/acquired immunodefi ciency syndrome

Table 2: Attitude and Belief about human immunodefi ciency virus/acquired immunodeficiency syndrome

Table 2: Attitude and Belief about human immunodefi ciency virus/acquired immunodeficiency syndrome

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