Changing professional practice in tuberculosis care: an educational intervention.
OBJECTIVE
This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa.


BACKGROUND
Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level. Despite efforts to improve quality of care for these patients, many fail to complete their treatment as prescribed. Poor rapport between health care providers and patients with tuberculosis is a major reason for non-adherence to treatment. Methods of improving the quality of care delivery and communication between health care providers and patients with tuberculosis is therefore a priority.


CONCLUSIONS
The paper outlines the stages of developing and implementing the education programme and reflects on this process. Data is drawn from an in-depth qualitative evaluation of the delivery and impacts of the intervention. The approach was acceptable to health care providers and adaptable to the needs of specific clinics. Participants evaluated the educational intervention positively, noting that it facilitated critical reflection on their work; encouraged problem-solving; and heightened their awareness of communication with patients and with colleagues. However, important structural barriers to practice change were identified, including conditions of service, relations with colleagues and support from management.


CONCLUSIONS
Experiential, participatory in-service education can be implemented on a large scale in primary care settings. However, the process is resource intensive and the impacts of such education may be limited by barriers at other levels of the health system.
Dick
Judy
J
Health Systems Research Unit, Medical Research Council of South Africa, Tygerberg, South Africa. judy.dick@mrc.ac.za
Lewin
Simon
S
Rose
Elizabeth
E
Zwarenstein
Merrick
M
Walt
Hester
H
D000293:Adolescent; D000328:Adult; D003142:Communication; D003695:Delivery of Health Care / Q000592:standards; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000209:etiology*; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000458:organization & administration; D011364:Professional Practice / Q000639:trends*; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000451:nursing*