title: Evaluation of lay health workers' needs to effectively support anti-tuberculosis treatment adherence in Malawi.
abstract: OBJECTIVE
  To identify barriers and facilitators to efforts by lay health workers (LHWs) to support anti-tuberculosis treatment adherence in Malawi to inform the design of a knowledge translation intervention for improving adherence.
  
  
  METHODS
  Qualitative study utilizing focus groups  and interviews conducted with LHWs providing tuberculosis (TB) care in Zomba District, Malawi.
  
  
  RESULTS
  Participants identified lack of knowledge, both general (understanding of TB and its treatment) and job-specific (understanding of tasks such as completion of treatment forms), as the  key barrier to LHWs in their role as adherence supporters. Lack of knowledge among LHWs providing TB care was reported to lead to a lack of confidence, conflicting messages given to patients, poor interactions with patients and errors in documentation. In addition to lack of knowledge, a number  of system barriers were identified as limiting LHWs' ability to function optimally, including a lack of physical resources, workload, communication delays and ineffective guardians.
  
  
  CONCLUSIONS
  Our findings suggest a gap between LHW knowledge and their responsibilities as adherence supporters.  The results have informed the development of an educational outreach intervention and point-of-care tool, to be evaluated in a randomized trial in Zomba District.
authors.affiliation: University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. lisa.puchalskiritchie@utoronto.ca
authors.forename: L M
authors.initials: LM
authors.lastname: Puchalski Ritchie
authors.forename: M
authors.initials: M
authors.lastname: van Lettow
authors.forename: J
authors.initials: J
authors.lastname: Barnsley
authors.forename: A K
authors.initials: AK
authors.lastname: Chan
authors.forename: M
authors.initials: M
authors.lastname: Joshua
authors.forename: A L C
authors.initials: AL
authors.lastname: Martiniuk
authors.forename: M J
authors.initials: MJ
authors.lastname: Schull
authors.forename: M
authors.initials: M
authors.lastname: Zwarenstein
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003142:Communication; D003150:Community Health Workers / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D016526:Workload; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents