"They are gaining experience; we are gaining extra hands": a mixed methods study to assess healthcare worker perceptions of a novel strategy to strengthen human resources for HIV in South Africa

Abstract

Background: Lay health workers (LHWs) can support the HIV response by bridging gaps in human resources for health. Innovative strategies are needed to expand LHW programs in many low- and middle-income countries. Youth Health Africa (YHA) is a novel LHW approach implemented in South Africa that places young adults needing work experience in one-year non-clinical internships at health facilities to support HIV programs (e.g., as HIV testers, data clerks). While research suggests YHA can increase HIV service delivery, we need to understand healthcare worker perceptions to know if this is an acceptable and appropriate approach to strengthen human resources for health and healthcare delivery.

Methods: We conducted a convergent mixed methods study to assess healthcare worker acceptance and perceived appropriateness of YHA as implemented in Gauteng and North West provinces, South Africa and identify issues promoting or hindering high acceptability and perceived appropriateness. To do this, we adapted the Johns Hopkins Measure of Acceptability and Appropriateness to survey healthcare workers who supervised interns, which we analyzed descriptively. In parallel, we interviewed frontline healthcare workers who worked alongside YHA interns and conducted an inductive, thematic analysis. We merged quantitative and qualitative results using the Theoretical Framework of Acceptability to understand what promotes or hinders high acceptance and appropriateness of YHA.

Results: Sixty intern supervisors responded to the survey (91% response rate), reporting an average score of 3.5 for acceptability and 3.6 for appropriateness, on a four-point scale. Almost all 33 frontline healthcare workers interviewed reported the program to be highly acceptable and appropriate. Perceptions that YHA was mutually beneficial, easy to integrate into facilities, and helped facilities be more successful promoted a strong sense of acceptability/appropriateness amongst healthcare workers, but this was tempered by the burden of training interns and limited program communication. Overall, healthcare workers were drawn to the altruistic nature of YHA.

Conclusion: Healthcare workers in South Africa believed YHA was an acceptable and appropriate LHW program to support HIV service delivery because its benefits outweighed its costs. This may be an effective, innovative approach to strengthen human resources for HIV services and the broader health sector.

Keywords: HIV/AIDS; Health systems strengthening; Implementation science; Lay health workers; Task shifting.

Fig. 1

Overview of the expanded Theoretical Framework of Acceptability (TFA) domains used in mixed methods analysis. Original domains are as defined by Sekhon, et al. [39], with addition of one domain, ‘facility fit’, influenced by the definition of ‘appropriate’ by Proctor, et al. [25]. Domains were grouped into three groups by this study’s authors

Fig. 2

Distribution of overall average acceptability and appropriateness scores for intern supervisors, by province (n = 60). Average scores of acceptability and appropriateness correspond to the following scale: 1 = Not at all, 2 = A little bit, 3 = A moderate amount, or 4 = A lot

Fig. 3

Summary of responses to acceptability and appropriateness questions on survey (n = 60). A: Responses to questions from perceived acceptability measure. B: Responses to questions from perceived appropriateness measure