Training for Health Professionals In Tanzania

Training for Health Professionals in Tanzania

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03923582

Acronym

THP

Enrollment

412

Registered

2019-04-22

Start date

2021-05-01

Completion date

2022-09-20

Last updated

2024-08-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Health Knowledge, Attitudes, Practice, Training

Brief summary

The goal of this randomized, controlled, single blinded trial is to evaluate the effectiveness of an Afrocentric sexual health curriculum on health professional students' knowledge, attitudes, and clinical skills in providing sexual health care in Tanzania.

Detailed description

There were 563 students recruited for the study that met the eligibility requirement. A total of 412 students gave consent and were randomized into intervention and control groups. At baseline, participants took a survey covering demographic information, educational background, sexual health knowledge, and attitudes toward sexual health topics. After completing the survey, participants participated in two standardized patient interviews involving actors role playing sexual health-related patient scenarios. Those who were in the intervention arm participated in a 4-day sexual health curriculum followed by a post-test survey measuring sexual health knowledge, attitudes, and evaluation of sexual health training. Three to four months later, intervention and waitlist control participants completed a follow-up survey assessing sexual health knowledge and attitudes toward sexual health topics and standardized patients scenarios. Multiple linear regression was used to assess the overall effectiveness of the sexual health curriculum on the attitudes, knowledge, and skills of health professionals after it has been implemented.

Interventions

BEHAVIORALComprehensive sexual health curriculum

This is a randomized, controlled, single blinded, trial, stratified by health profession, of the intervention versus waitlist control assessing knowledge, attitude change and skill development. At the end of the intervention as compared with waitlist controls. The intervention was a 4-day, Afrocentric, comprehensive sexual health curriculum. Tanzanian faculty wrote the curriculum in English and Kiswahili to address the most common sexual health challenges clinicians experience in Tanzania. The 4-day curriculum covers sexual health across the lifespan, LGBT and sexual violence, clinical skills training, ethics and policy writing, and community resources and cultural considerations.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE (Outcomes Assessor)

Masking description

A randomized, controlled, single blinded trial, stratified by health profession, of the intervention vs waitlist control.

Intervention model description

Development and testing of a sexual health curriculum for Midwifery, Nursing and Medical Students.

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

1. current student at MUHAS in midwifery, nursing, or medicine. 2. 3rd or 4th year for medical students or 2nd or 3rd year for nursing and midwifery students. 3. able to attend the full 4-day training during the first week of student vacation. 4. fluent in English (the language of instruction at MUHAS) and Kiswahili (the lingua franca in Tanzania). 5. willing to volunteer and complete all evaluation procedures.

Exclusion criteria

1. students who will not be able to attend MUHAS all days of the seminar or be on the MUHAS campus for the follow-up dates. 2. students who express severe reservations about attending (e.g., due to religious objections). 3. Students who express fear of violence due to attending (e.g., from a spouse or relative).

Design outcomes

Primary

Measure	Time frame	Description
Change in Sexual Health Knowledge Score From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	Sexual health knowledge was assessed using 16 multichoice items created by the research team. The items covered female sexual health concerns (2 items), sexual development and masturbation (3 items), sexual orientation (3 items), sexual violence (3 items), sexuality in middle age (3 items), sexual history taking and sexual counseling (2 items). Total scores were used for analysis (maximum total score of 16). Participants get one point for every item they answer correctly. Because there are 16 items in this section, participants can have a minimum total score of 0 and a maximum total score of 16. A higher score signifies better sexual health knowledge. A single value was calculated for the intervention arm and waitlist control from difference scores (calculated as follow-up minus baseline scores).
Change in Sexual Health Attitudes: Confidence in Ability to Discuss From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	Confidence in their ability to discuss the sexual health of patients, and confidence in their ability to discuss their patients' sexual health concerns were assessed using the Sexual Health Education for Professionals Scale (SHEPS). This section consists of 37 items where participants rate their confidence from (1) very unconfident to (5) confident. Because there are 37 items in this section, participants can have a minimum total score of 37 and a maximum total score of 185. A higher value signifies better confidence in the ability to discuss sexual health topics. A single value was calculated for the intervention arm and waitlist control from difference scores (calculated as follow-up minus baseline scores).
Change in Sexual Health Attitudes: Confidence in Having Knowledge From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	Confidence in their knowledge to assess the sexual health of patients, and confidence in their ability to discuss their patient's sexual health concerns were assessed using the Sexual Health Education for Professionals Scale (SHEPS). This section consists of 37 items where participants rate their confidence from (1) very unconfident to (5) confident. Because there are 37 items in this section, participants can have a minimum total score of 37 and a maximum total score of 185. A higher value signifies better confidence in having knowledge of sexual health topics. A single value was calculated for the intervention arm and waitlist control from difference scores (calculated as follow-up minus baseline scores).
Change in Sexual Counseling Skills: Interpersonal Communications From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	Skills were assessed by faculty raters assessing two videos (per each time point) of student counseling blind to whether the participant was in the intervention or control group and whether the assessment was at baseline or follow-up. Each participant was rated on 10 items assessing their interpersonal communication (IC) abilities. Each item was on a 3-point scale (0=not done; 1=partially done; 2=done). The scale has a minimum score of 0 and a maximum score of 20 per video. We aggregated scores for each time point by summing the two videos at each time point. Therefore, the minimum total score is 0 and the maximum total score is 40. A higher score value signifies better interpersonal communication skills. A single value was calculated for the intervention arm and waitlist control from difference scores based on the sum of the scores at baseline and the sum of the scores at followup.
Change in Sexual Counseling Skills: Medical History Taking From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	Skills were assessed by faculty raters assessing the two videos (per time point) of student counseling blind to whether the participant was in the intervention or control group and whether the assessment was at baseline or follow-up. Medical history taking (MHT) was rated by six key pieces of information on a 2-point scale, where 0=not obtained information and 1=obtained information. The scale has a minimum score of 0 and a maximum score or 6 per video. We aggregated scores for each time point by summing the two videos at each time point. Therefore, the minimum total score is 0 and the maximum total score is 12. A higher score value signifies better medical history taking skills. A single value was calculated for the intervention arm and waitlist control from difference scores based on the sum of the scores at baseline and the sum of the scores at followup.
Change in Sexual Health Beliefs From Baseline to Follow-up	At Baseline and 3-4 months Follow-up	The SHEPS Attitudes section comprises 27 items. Participants rate their level of agreement (1=strongly agree; 5=strongly disagree), with 13 items being reverse coded. Because there are 27 items in this section, participants can have a minimum total score of 27 and a maximum total score of 135. Low scores correspond to liberal views and high scores correspond to conservative views. A single value was calculated for the intervention arm and waitlist control from difference scores (calculated as follow-up minus baseline scores).

Countries

Tanzania, United States

Participant flow

Participants by arm

Arm	Count
Intervention Arm A four-day comprehensive sexual health curriculum tailored for Africa. Comprehensive sexual health curriculum: This is a randomized, controlled, single blinded, trial, stratified by health profession, of the intervention versus waitlist control assessing knowledge, attitude change and skill development. At the end of the intervention as compared with waitlist controls. The intervention was a 4-day, Afrocentric, comprehensive sexual health curriculum. Tanzanian faculty wrote the curriculum in English and Kiswahili to address the most common sexual health challenges clinicians experience in Tanzania. The 4-day curriculum covers sexual health across the lifespan, LGBT and sexual violence, clinical skills training, ethics and policy writing, and community resources and cultural considerations.	206
Waitlist Control Participants in this arm completed a follow-up survey and were scheduled to receive the intervention after the end of the trial.	206
Total	412

Baseline characteristics

Characteristic	Intervention Arm	Total	Waitlist Control
Age, Continuous	23.90 years STANDARD_DEVIATION 2.36	24 years STANDARD_DEVIATION 2.46	24.05 years STANDARD_DEVIATION 2.56
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	206 Participants	412 Participants	206 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	0 Participants	0 Participants	0 Participants
Sex/Gender, Customized Female	64 Participants	126 Participants	62 Participants
Sex/Gender, Customized Male	137 Participants	276 Participants	139 Participants
Sex/Gender, Customized Other/Prefer not to answer	5 Participants	10 Participants	5 Participants
Sexual Counseling Skills: Interpersonal Communications	22.583 units on a scale STANDARD_DEVIATION 4.198	22.267 units on a scale STANDARD_DEVIATION 4.308	21.951 units on a scale STANDARD_DEVIATION 4.403
Sexual Counseling Skills: Medical History Taking	6.019 units on a scale STANDARD_DEVIATION 2.419	6.024 units on a scale STANDARD_DEVIATION 2.405	6.029 units on a scale STANDARD_DEVIATION 2.397
Sexual Health Attitudes: Confidence in Having Knowledge	150.141 units on a scale STANDARD_DEVIATION 24.43	150.422 units on a scale STANDARD_DEVIATION 24.442	150.704 units on a scale STANDARD_DEVIATION 24.511
Sexual Health Belief	79.825 units on a scale STANDARD_DEVIATION 9.292	79.073 units on a scale STANDARD_DEVIATION 9.443	78.320 units on a scale STANDARD_DEVIATION 9.555
Sexual Health Knowledge	6.170 units on a scale STANDARD_DEVIATION 2.113	6.299 units on a scale STANDARD_DEVIATION 2.103	6.427 units on a scale STANDARD_DEVIATION 2.091
Sexual Health Knowledge: Confidence in Ability to Discuss	153.485 units on a scale STANDARD_DEVIATION 20.632	153.165 units on a scale STANDARD_DEVIATION 20.97	152.8452 units on a scale STANDARD_DEVIATION 21.349

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 0	0 / 0
other Total, other adverse events	0 / 0	0 / 0
serious Total, serious adverse events	0 / 0	0 / 0

Outcome results

Primary

Change in Sexual Counseling Skills: Interpersonal Communications From Baseline to Follow-up

Skills were assessed by faculty raters assessing two videos (per each time point) of student counseling blind to whether the participant was in the intervention or control group and whether the assessment was at baseline or follow-up. Each participant was rated on 10 items assessing their interpersonal communication (IC) abilities. Each item was on a 3-point scale (0=not done; 1=partially done; 2=done). The scale has a minimum score of 0 and a maximum score of 20 per video. We aggregated scores for each time point by summing the two videos at each time point. Therefore, the minimum total score is 0 and the maximum total score is 40. A higher score value signifies better interpersonal communication skills. A single value was calculated for the intervention arm and waitlist control from difference scores based on the sum of the scores at baseline and the sum of the scores at followup.