An analysis of factors affecting health-workers application of the routine HIV testing and counseling (RHT) protocol

Theu, Joe (2014-04)

Thesis (MPhil)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Not all patients who come to the hospital are offered Routine HIV Testing and Counseling (RHT) as is expected by the Ministry of Health of Botswana’s Routine HIV Testing and Counseling Protocol. This study sought to unearth in detail, factors that affect health-workers in Thamaga Primary Hospital in their application of RHT. A qualitative study was used to get lived experiences of health-workers working at Thamaga Primary Hospital. Semi-structured in-depth interviews were conducted with 4 groups of health workers and with 6 individual health-workers. Content analysis was done on the data collected selecting emerging themes deductively. Relational analysis was conducted to gain the meaning of the findings. The findings of the deductive analysis were also compared inductively with The Porter-Lawler Theory of Motivation to see if theory was applicable in HIV work or applicable to health-worker motivation. Seven main factors that affect RHT either positively or negatively emerged: accountability, health-worker knowledge, human rights, workload, resources, patients’ age and patients’ knowledge. Accountability (36.8%) was by far, the dominant factor that influenced RHT positively when it was present and negatively when it was absent. The other two factors which had sizable portions were knowledge of RHT (21.2%) and human rights issues (20.2%). When concept mapping was done to find meaning, lack of knowledge of RHT was found to lead to poor understanding of human rights which led to poor accountability that led to the many other factors that were inter-related and ultimately directly or indirectly influenced performance levels of RHT. When tested against the findings, The Porter-Lawler Theory of Motivation was congruently applied to factors that arose with minor discrepancies on intrinsic factors making it largely relevant to HIV work or health-worker motivation. The findings call for training of health-workers on RHT and human rights issues accompanied by concurrent application of performance monitoring and appraising tools like Performance Based Reward Systems/ Performance Development Plans (PBRS/PDPs) that enhance accountability. Use of The Porter-Lawler Theory in HIV work or health-worker motivation is still applicable and is recommended where underlying factors are less well understood or not yet researched.

AFRIKAANSE OPSOMMING: Nie alle pasiënte wat die hospitaal besoek ontvang roetine-MIV-toetsing en voorligting (RHT), soos deur die Ministerie van Gesondheid van Botswana se Roetine-MIV-Toetsing en Voorligtingsprotokol verwag word nie. Hierdie studie het ’n uitvoerige ondersoek onderneem van faktore wat gesondheidswerkers by Thamaga Primary Hospital affekteer in hulle toepassing van RHT. Daar is gebruik gemaak van ’n kwalitatiewe studie om aktuele ervarings te verkry van gesondheidswerkers wat by die Thamaga Primary Hospital werk. Semi-gestruktureerde diepte-onderhoude is gevoer met vier groepe gesondheidswerkers en ses individue. ’n Inhoudsontleding van die data wat versamel is, is gedoen om ’n deduktiewe seleksie van temas wat ontstaan het te doen. ’n Ontleding van verwante inligting is gedoen om bevindings betekenisvol te orden. Die bevindings van die deduktiewe analise is ook induktief vergelyk met die Porter-Lawler-motiveringsteorie om te bepaal of die teorie op MIV-werk of op gesondheidswerkermotivering toepaslik was. Die volgende sewe hooffaktore wat RHT positief of negatief affekteer het hieruit geblyk: toerekenbaarheid, gesondheidswerkerkennis, menseregte, werklas, hulpbronne, pasiëntouderdom en pasiënte se kennis. Toerekenbaarheid (36.8%) was verreweg die dominante faktor wat RHT beïnvloed het, positief wanneer dit teenwoordig was en negatief wanneer dit afwesig was. Die ander twee faktore wat aanmerklik verteenwoordig is was kennis van RHT (21.2%) en menseregtekwessies (20.2%). Met die toepassing van begripbeelding om betekenis te bepaal, het dit geblyk dat gebrek aan kennis van RHT lei tot ’n swak begrip van menseregte, wat gelei het tot swak toerekenbaarheid, wat weer gelei het tot baie ander onderling verwante faktore wat uiteindelik regstreeks of onregstreeks die prestasievlakke van RHT beïnvloed het. Met die toetsing teen die bevindings is die Porter-Lawler-motiveringsteorie ooreenstemmend toegepas op faktore wat ontstaan het, met klein teenstrydighede oor intrinsieke faktore wat dit baie relevant vir MIV-werk of gesondheidswerkermotivering gemaak het. Die bevindings vereis opleiding van gesondheidswerkers in RHT en menseregte-aangeleenthede saam met gelyktydige toepassing van prestasiemonitering en waardebepalingsinstrumente, soos prestasiegebaseerde beloningstelsels (PBRS) en/of prestasieontwikkelingsplanne (PDPs), wat toerekenbaarheid verbeter. Gebruik van die Porter-Lawler-teorie in MIV-werk of gesondheidswerker-motivering is nog toepaslik en word aanbeveel waar onderliggende faktore minder goed verstaan word of nog nie nagevors is nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86386
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