Final Products Report Jeffrey A. Sheldon, M. A., Ed. M. Applied Social Science Research & Evaluation Intern Psycho-social Support & Counselling Programme Sinikithemba HIV/Aids Care Centre & Advanced Doctoral Student School of Behavioral & Organizational Sciences Claremont Graduate University The Claremont Colleges Claremont, California, USA
Motivations:• The current organizational climate at Sinikithemba & McCord Hospital is one of readiness and commitment to change and growth.• Moving forward the quality improvement processes already begun around the systems that support HIV+ patients towards achieving the highest possible level of ARV adherence.• Continued systemization of processes and functions.
Intentions:• Producing tools that initiate discussions, compel action, and inform decisions around the process of continuous quality improvement.• Work that can be implemented without my further involvement.• Serving as a point of departure for other applied social scientists and evaluators.
Process:• Ten weeks & approximately 400 hours working closely with both the psycho-social support team and counseling staff.• Observations, reviewing documents, and discussions with staff about processes and functions.
The “Compendium:”• Provides a rationale for each project.• Delineates implementation and management tasks, and what has been done to date.• Offers implementation and management tasks yet to be undertaken as suggestions for future project direction.
Projects Started & Developed:• On-going Counselling Pilot Study• Sinikithemba ART Patient Training Knowledge, Attitudes, & Beliefs Assessment Pilot Study• Situational Analysis of McCord Hospital’s HIV/Aids Counselling Programme• Psycho-social Screening Tool Additions to Trak Health• Sinikithemba Counselling Programme Situational Analysis & Training Needs Assessment• Sinikithemba Forms & Training Materials Evaluation• External Research & Evaluation Proposal to McCord Hospital/Sinikithemba HIV/Aids Clinic
On-Going Counselling PilotStudy:• Purpose: Testing the concept of on-going counseling from the perspective of a more proactive approach to engaging with patients.• Utility: Ready for full implementation - the protocol, counsellor guidelines, and a data collection tool have been developed.
ART Patient TrainingAssessment Methods PilotStudy:• Purpose: To test which of the proposed knowledge assessment methods, or some combination thereof works best with our patient population.• Utility: There is a pool of questions – oral, written, and pictorial from which to draw items for testing which mode of assessment or some combination thereof is most effective. One type of study (quasi-experimental, post-only) has been designed and there is a protocol that can be followed for its implementation.
Situational Analysis Of McCordHospital’s HIV/AidsCounselling Programme:• Purpose: 1) Increasing the awareness of how patients move throughout the system, in particular where counselling is used as an intervention, and 2) what the ideal patient process might entail from that perspective.• Utility: Serving as a point of departure for 1) evaluating the gaps between the current patient system and the ideal patient system, and 2) beginning a dialogue around the development of a planning and implementation process for filling in those gaps. Sometimes, awareness is enough to compel action.
Psycho-Social Screening ToolAdditions To Trak Health:• Purpose: Improving the quality and quantity of information about patients such that non-adherence risk- factors can be “red flagged” earlier in the system and interventions put in place.• Utility: Serving as a catalyst for discussions about quality improvements in the flow and management of patient information and providing a mock-up of what pages might look like on the Trak Health system.
Counselling ProgrammeSituational Analysis & TrainingNeeds Assessment:• Purpose: Continuing the work started by Monty & Stephanie Thomas around development of a counselor training program through integration of additional evidenced-based counselor competencies and standards.• Utility: Serving as a catalyst that will bring together for dialogue existing, yet disparate elements of a formal, comprehensive counselor training program, e.g., the Training Centre, the Resource Centre, the Psychology Department, et al.
Sinikithemba Forms & TrainingMaterials Evaluation:• Purpose: Creating awareness of 1) all the forms that are used either directly or indirectly by counseling staff and how patient information moves throughout the system, and 2) all the printed materials that are used by counselors or provided to patients during training.• Utility: Serving as a catalyst for discussions about the utility of each form to determine 1) revisions that need to be made, if any; 2) which forms currently in use would better serve in an electronic format; 3) the types of forms that need to be added; and 4) the accessibility vis-à-vis quality and quantity of the information patients receive.
External Research & EvaluationProposal:• Purpose: Providing a list of questions to be asked of potential external researchers and evaluators as an indication of their general competency in conducting research or evaluation and the motive behind such work.• Utility: Can be used to pre-screen external researchers and evaluators by the Ethics Committee and anyone else impacted by the proposed work.
The Final Analysis:• This work should be utilized wholly at the discretion of those who are charged with implementing these projects and studies.• This work should be reviewed by more than one person and that as time permits, discussions take place as a collective so any resulting decisions about the use of these materials are mutually agreed upon.• Any one project or study is likely to impact multiple areas across both Sinikithemba and McCord so involvement of the many will be more beneficial than involvement of the few.