An analysis of the experiences of HCWs in improving their performance in the workplace following a multi-method training intervention in a resource-limited setting
| dc.contributor.advisor | Blitz, Julia | en_ZA |
| dc.contributor.author | Proudfoot, Ian Graham | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education. | en_ZA |
| dc.date.accessioned | 2021-11-02T08:12:55Z | |
| dc.date.accessioned | 2021-12-22T14:18:14Z | |
| dc.date.available | 2021-11-02T08:12:55Z | |
| dc.date.available | 2021-12-22T14:18:14Z | |
| dc.date.issued | 2021-12 | |
| dc.description | Thesis (MPhil)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY : Introduction: The educational outcomes of training initiatives are usually measured against the achievement of specific quantifiable objectives. This study sought instead to analyse the impact on changed workplace performance of a training curriculum through the personal experiences of the healthcare workers themselves. The three-week training intervention was a combination of classroom, bedside and workplace-based education, aiming to upskill a group of twenty hospital- and primary care-based clinicians in the management of advanced HIV in a rural community in Homa Bay in Western Kenya. The intention of the study was to understand more deeply what elements facilitated improved workplace performance and what challenged it. In so doing, it was hoped that lessons would be learnt to guide the further development of this and other short training curricula of this nature in similar low- and middle-income settings. Methods: Following a phenomenological line of enquiry, in-depth, semi-structured interviews were conducted fourteen months after the training intervention on a convenience sample of twelve of the twenty participants in the training course. The open-ended questions probed the factors leading to success and those challenging improvement in workplace performance, whilst opportunity was also created for free expression of other elements considered relevant. The interview data were analysed following standard interpretive, phenomenological analysis procedures, with the data finally classified into core themes, within two broad categories of factors that promoted improved performance and those that challenged it. CME - Continuing medical education MOH - Ministry of health HCW - Healthcare worker MSF - Médecins Sans Frontières MIV - Menslike immuniteitsgebreksvirus TLU - Teaching and learning unit LMIC - Low- and middle-income countries NGO - Non-governmental organisation Results: Three core areas of workplace performance were impacted positively by the training intervention, namely, clinical skills, teaching competence, and program development. Contributing to this were a number of different elements, including the classroom teaching strategies, the reference texts provided, the bedside teaching, and the engagements with a variety of colleagues in the workplace over the subsequent months. The challenges to improved performance fit into two broad categories: weaknesses in the healthcare system, and the negative influences of people, including senior colleagues, ministry of health counterparts, junior colleagues, or the patients themselves. Conclusions: Similar to the roles played by a sports coach, the role of the educator is not only to facilitate improved technical skills but also to recognise and further develop the individual agency of the players and to build resilience to thrive, even in adversity. Drawing on the established learning theories of adult learning, situated learning and social constructivism, further augmented by a wealth of empiric evidence in health education studies in low- and middle-income countries, the teaching and learning strategies were shown to contribute significantly to improved workplace performance. The individual agency of the healthcare workers, especially in teaching and program management roles in primary care was a surprise finding, pointing us, as educators, to a greater focus in the future towards not only anticipating this but also taking specific steps to harness this potential. Finally, in the face of the numerous challenges to improved workplace performance, all too frequently encountered in these rural settings, attention needs to be focused in the future on building greater resilience and capacity to manage these challenges. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING : Inleiding: Die opvoedkundige uitkomste van spesifieke opleidingsinisiatiewe word gewoonlik gemeet aan die bereiking van spesifieke kwantifiseerbare doelstellings. In hierdie studie is daar eerder gepoog om die impak op veranderde werksplekprestasies van 'n opleidingskurrikulum te ontleed deur middel van die persoonlike ervarings van die gesondheidswerkers self. Die opleidingsintervensie van drie weke het bestaan uit 'n kombinasie van onderrig in die klaskamer, praktiese onderrig langs pasiënte se beddens in die hospitaal, en onderrig in die werksplek self. Dit was daarop gemik om 'n groep van twintig klinici, van wie sommige in die hospitaal self gewerk het, en ander in die veld van primêre sorg, op te lei in die bestuur van gevorderde Menslike immuniteitsgebreksvirus (MIV) in 'n landelike gemeenskap in Homa-baai in Wes-Kenia. Die doel van die studie was om 'n beter begrip te ontwikkel van die aspekte wat 'n verbetering in prestasie in die werksplek moontlik maak, en watter aspekte dit bemoeilik of belemmer. Die hoop het bestaan dat daar uit hierdie projek rigtingwysers sou verskyn wat die verdere ontwikkeling van hierdie spesifieke kurrikulum sou aanhelp, asook dié van ander soortgelyke kort opleidingskurrikula in vergelykbare omgewings met 'n lae- en middelinkomste. Metodes: 'n Fenomenologiese ondersoekmetode is gebruik, en veertien maande na die intervensie, is in-diepte, semi-gestruktureerde onderhoude gevoer met 'n gerieflikheidssteekproef van twaalf van die twintig deelnemers in die opleidingskursus. Die ope vrae het ondersoek ingestel na beide die faktore wat bygedra het tot sukses, asook die faktore wat 'n verbetering in werksplekprestasie belemmer het. Die geleentheid is ook geskep vir die vrye melding van ander faktore wat as relevant beskou is. Die data van die onderhoude is geanaliseer volgens standaard interpretatiewe, fenomenologiese ontledingsprosedures, en die data is uiteindelik geklassifiseer volgens sekere kerntemas, binne twee breë kategorieë van faktore wat verbeterde prestasie bevorder het, en die faktore wat dit belemmer het. Resultate: Drie kernareas van werkplekprestasie is positief beïnvloed deur die opleidingsintervensie, naamlik kliniese vaardighede, onderrigvaardigheid en programontwikkeling. 'n Aantal verskillende faktore het hiertoe bygedra, naamlik onderrigstrategieë in die klaskamer, die verwysingstekste wat verskaf is, die praktiese onderrig langs pasiënte se beddens, en die waardevolle gesprekke met 'n verskeidenheid kollegas in die werksplek in die maande daarna. Die faktore wat belemmering meegebring het pas in twee breë kategorieë, naamlik tekortkominge in die gesondheidsorgstelsel self, en die negatiewe houding van sommige medewerkers, wat senior kollegas, sommige verteenwoordigers van die ministerie van gesondheid, junior kollegas of die pasiënte self, ingesluit het. Gevolgtrekkings: Die rol van 'n opvoeder is vergelykbaar met die rol wat 'n sportafrigter vertolk: dit bestaan nie net daaruit om verbeterde tegniese vaardighede te bewerkstellig nie, maar om ook om die individuele vermoë van die spelers raak te sien, en verder te ontwikkel. Die doel is om hulle in staat te stel om uithouvermoë en deursettingsvermoë verder te ontwikkel, wat hulle daartoe in staat sal stel om goed te vaar, selfs onder moeilike omstandighede. Daar is gesteun op gevestigde leerteorieë op die gebied van volwasse leer, gesitueerde leer en sosiale konstruktivisme. Dis verder aangevul deur 'n magdom empiriese bewyse in gesondheidsopvoedkunde-studies in lande met lae- en middelinkomste, en hulle het getoon dat onderrig- en leerstrategieë beduidend bydra tot die verbeterde prestasie in die werksplek. Die individuele ondernemingsgees en bydraes van die gesondheidsorgwerkers, veral van diegene in onderrig- en programbestuursrolle op die gebied van primêre sorg, was 'n verrassende bevinding. Dit het aan ons as opvoeders aangedui het dat dit belangrik was om in die toekoms daarop te fokus, en om dit nie bloot te verwag nie. Ons moet stappe doen om hierdie potensiaal te benut. Ten slotte, gesien teen die agtergrond van die talle struikelblokke wat in die pad staan van verbeterde werksplekprestasies, wat algemeen in hierdie landelike omgewing voorkom, moet daar in die toekoms meer gefokusde aandag geskenk word aan die opbou en aanmoediging van meer uithouvermoë en deursettingsvermoë om gesondheidswerkers daartoe in staat te stel om hierdie struikelblokke te oorkom. | af_ZA |
| dc.description.version | Masters | |
| dc.format.extent | 63 pages ; illustrations, includes annexures | |
| dc.format.extent | Stellenbosch : Stellenbosch University | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/123730 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Medical personnel -- Training -- Curriculum -- Homa Bay (Kenya) | en_ZA |
| dc.subject | Medical personnel -- Attitudes -- Homa Bay (Kenya) | en_ZA |
| dc.subject | Career development -- Homa Bay (Kenya) | en_ZA |
| dc.subject | Career development -- Developing countries | en_ZA |
| dc.subject | UCTD | |
| dc.title | An analysis of the experiences of HCWs in improving their performance in the workplace following a multi-method training intervention in a resource-limited setting | en_ZA |
| dc.type | Thesis | en_ZA |