The design, implementation and evaluation of an HIV counselling skills programme for lay counsellors
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Date
2020
Authors
Mmusi-Makhele, Lerato
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Lay counsellors provide the majority of public health with HIV counselling and testing services in sub-Saharan Africa, including South Africa. Although lay counsellors are not formally employed, these volunteers provide a variety of basic healthcare services both in facility and community-based programmes. Lay counsellors are not professionally trained, and challenges have been identified in their counselling skills and competence. The study aimed to develop, implement and evaluate an HIV counselling skills training programme for lay counsellors in the Mangaung Metropolitan Municipality in the Free State Province, South Africa.
An experimental approach through a concurrent triangulation mixed-method design was utilised. Using a pretest-posttest non-equivalent method, 107 lay counsellors were selected through multi-stage non-probability purposeful sampling. Structured interviews, focus group discussions, and the observation of counselling sessions were employed to collect quantitative and qualitative data. The UNAIDS Tools for evaluating Voluntary HIV counselling and testing and the Maslach Burnout Inventory were used to measure the variables in the study. Quantitatively, a cross-sectional, correlational, and criterion-group design was used, while thematic content analysis was used to analyse the qualitative data.
The results indicated that lay counsellors had inadequate counselling skills and displayed limited competence, especially in pre-HIV test counselling, TB and PMTCT interventions. These results indicate that lay counsellors found it difficult to manage sensitive situations with patients. However, the Mann-Whitney test compared the differences between the experimental and the control groups and indicated no statistical difference in HIV content-based elements. No statistical difference on the competence-based elements in pre- and post-intervention were found for the experimental group. In addition, the participants reported a significant level of emotional exhaustion and work and systemic challenges such as lack of support, supervision, formal employment opportunities, and limited time to conduct counselling and unsafe working environments.
However, the MANOVA showed no statistical difference in the emotional exhaustion subscale of the MBI amongst the experimental group.
The study indicates gaps in the execution of HIV counselling within HCT services, although the HIV counselling skills training programme was unable to address these discrepancies. The study did reveal systemic and work-related indicators that impact HIV counselling provided by lay counsellors. The need for further counselling training is an arguable one, which should allow for a longer time frame, evaluation and monitoring to meet the needs of HCT services. Future studies should consider longitudinal research, and given the implications of work-related conditions reported, studies can include systemic variables, service users and measures that would address these aspects. In practice, counselling skills and competence are reinforced through regular supervision and on-going training, and this should be standard. Also, reorganising recruitment practices and creating employment opportunities should be prioritised to promote the selection of suitable candidates as lay counsellors.
Description
Keywords
HIV counselling, Lay counsellors, Counselling skills, Competence, Burnout, Training, Mixed-method research