A primary health care intervention to mobilize health workers for HIV prevention in Malawi

Abstract

For the last 4 years we have implemented a model to mobilize rural health workers as leaders for HIV prevention in Malawi. We use a conceptual framework that integrates the World Health Organization's (WHO) primary health care (PHC) model, the socialcognitive model of behavioural change, and contextual tailoring of the intervention. Health workers are potential rural HIV prevention leaders because they have community trust and respect. However, their leadership potential has been limited by both health system barriers such as inadequate workers, supplies, and training and personal barriers such as risky occupational and personal behaviours. In the first phase of the project, we developed collaborative relationships and conducted qualitative research to adapt a peer group intervention for rural health workers and community members. In the ongoing second phase, we trained the health workers, who then volunteered and provided the intervention to adults in the communities their health centres serve. The intervention was adapted for young people through a community participatory process. Currently the adapted intervention is being offered to young people. As a guide to replication, we discuss barriers encountered in implementing this collaborative project and how we overcame them. This project demonstrates that health workers can be effective leaders for community AIDS prevention in African countries. The primary health care model offers a feasible, cost-effective and sustainable approach to maximizing health worker-community collaboration to reduce the spread of HIV.

Impacts of a Peer-Group Intervention on HIV-Related Knowledge, Attitudes, and Personal Behaviors for Urban Hospital Workers in Malawi

“…The data collection instrument was initially developed for the authors’ Botswana studies (Norr et al, 2004) and revised for their Malawi primary school teachers'study (Norr et al, 2007) and the district health worker study described previously (Norr et al, 2006). The health worker variables presented here measure personal HIV prevention-related knowledge, attitudes, and HIV prevention behaviors.…”

“…This study grew out of the authors’ research to mobilize district health workers as HIV prevention leaders for rural communities described previously (Norr et al, 2006). The authors’ work at a rural district hospital made them aware that urban hospital workers also needed an intervention that would help them become leaders in HIV prevention at their workplaces and in their communities.…”

“…The authors then focused on developing and testing an intervention for rural communities that took advantage of health workers’ potential to be HIV prevention leaders (Norr et al, 2006). The intervention was based on an innovative conceptual framework that integrated the World Health Organization primary health care model, social-cognitive learning theory, and contextual tailoring.…”

Improving universal precautions and client teaching for rural health workers: a peer-group intervention

“…The intervention differs in several ways from the usual in-service training programs health workers receive. As described in Norr et al (2006) intervention implementation is guided by the World Health Organization's primary health care model of health worker-community collaboration, building on the existing health care system to deliver the intervention in rural communities. The conceptual model also incorporates behavioral change theories and contextual tailoring to guide the content and learning processes of the intervention.…”

“…This paper describes the effects of a peer-group intervention on universal precautions and client teaching for rural health workers in Malawi. These data are part of a larger study to mobilize district health workers as HIV prevention leaders (Norr et al, 2006). …”