title: Lay Health Workers experience of a tailored knowledge translation intervention to improve job skills and knowledge: a qualitative study in Zomba district Malawi.
abstract: BACKGROUND
  Like many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers. In response to this crisis, a formal cadre of lay health workers (LHW) has been established and now carries out several basic health care services, including outpatient TB care and adherence support. While ongoing training and supervision are recognized as essential to the effectiveness of LHW programs, information is lacking as to how these needs are best addressed. The objective of this qualitative study was to explore LHWs responses to a tailored knowledge translation intervention they received, designed to address a previously identified training and knowledge gap.
  
  
  METHODS
  Forty-five interviews were conducted with 36 healthcare workers. Fourteen to sixteen interviews were done at each of 3 evenly spaced time blocks over a one year period, with 6 individuals interviewed more than once to assess for change both within and across individuals overtime.
  
  
  RESULTS
  Reported benefits of the intervention included: increased TB, HIV, and job-specific knowledge; improved clinical skills; and increased confidence and satisfaction with their work. Suggestions for improvement were less consistent across participants, but included: increasing the duration of the training, changing to an off-site venue, providing stipends or refreshments as incentives, and adding HIV and drug dosing content.
  
  
  CONCLUSIONS
  Despite the significant departure of the study intervention from the traditional approach to training employed in Malawi, the intervention was well received and highly valued by LHW participants. Given the relative low-cost and flexibility of the methods employed, this appears a promising approach to addressing the training needs of LHW programs, particularly in Low- and Middle-income countries where resources are most constrained.
authors: Department of Medicine, University of Toronto, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.|Department of Emergency Medicine, University Health Network, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.
authors: Lisa M
authors: LM
authors: Puchalski Ritchie
authors: Dignitas International, Zomba, Malawi. m.vanlettow@dignitasinternational.org.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. m.vanlettow@dignitasinternational.org.
authors: Monique
authors: M
authors: van Lettow
authors: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. jan.barnsley@utoronto.ca.
authors: Jan
authors: J
authors: Barnsley
authors: Department of Medicine, University of Toronto, Toronto, ON, Canada. a.chan@dignitasinternational.org.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. a.chan@dignitasinternational.org.|Dignitas International, Toronto, Canada. a.chan@dignitasinternational.org.|Sunnybrook Health Sciences Center, Toronto, ON, Canada. a.chan@dignitasinternational.org.
authors: Adrienne K
authors: AK
authors: Chan
authors: Department of Medicine, University of Toronto, Toronto, ON, Canada. mjs@ices.on.ca.|Dignitas International, Toronto, Canada. mjs@ices.on.ca.|Sunnybrook Health Sciences Center, Toronto, ON, Canada. mjs@ices.on.ca.
authors: Michael J
authors: MJ
authors: Schull
authors: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. amartiniuk@georgeinstitute.org.au.|Dignitas International, Toronto, Canada. amartiniuk@georgeinstitute.org.au.|George Institute for Global Health, Sydney, Australia. amartiniuk@georgeinstitute.org.au.|The University of Sydney, Sydney, Australia. amartiniuk@georgeinstitute.org.au.
authors: Alexandra L C
authors: AL
authors: Martiniuk
authors: National TB Control Program, Ministry of Health, Lilongwe, Malawi. a_makwakwa@yahoo.com.
authors: Austine
authors: A
authors: Makwakwa
authors: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. merrick.zwarenstein@ices.on.ca.|Knowledge translation unit, Lung Institute, University of Cape Town, Cape Town, South Africa. merrick.zwarenstein@ices.on.ca.|Stellenbosch University Faculty of Health Sciences, Tygerberg, South Africa. merrick.zwarenstein@ices.on.ca.|Department of Family Medicine, Western University, London, ON, Canada. merrick.zwarenstein@ices.on.ca.
authors: Merrick
authors: M
authors: Zwarenstein
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003150:Community Health Workers / Q000193:education* / Q000592:standards; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D058996:Quality Improvement; D057170:Translational Research, Biomedical