The development and evaluation of a social work programme for community caregivers to facilitate HIV and AIDS patients' adherence to antiretroviral treatment

Abstract

The study focused on the empowerment of community caregivers to facilitate patients' adherence to antiretroviral treatment (ART). Adherence to ART poses a great challenge and ART success is highly dependent on the ability of the patient to fully adhere to the prescribed treatment. The overall aim of this study was to develop an empowerment programme for community caregivers to facilitate patients' adherence to ART. The research followed a mixed method approach and particularly the multiphase mixed method in which both qualitative and quantitative methodology was used. The intervention research model was used which consists of six phases, namely, problem analysis and project planning, information gathering and synthesis, design, early development and pilot testing, evaluation and advance development and dissemination. The investigation focused on four phases. Phase one focused on a literature review, phase two focused on the need assessment and planning, phase three focused on the development of the social work empowerment programme and phase four focused on the implementation and evaluation of the social work empowerment programme. Section A contains the general introduction to the study, problem statement, research objectives, the procedures and research methodology. Furthermore the limitations of this study are discussed as well as the definitions of key words and the composition of the research report is given. Section B contains the results of the research according to the different articles. Each article focuses on specific goals and research methodologies which were done in order to achieve the overall goal to develop the empowerment programme. In article 1 a theoretical perspective from the literature was obtained to determine the challenges that patients experience with regard to ART from the perspective of community caregivers. The aim of the literature study in article 1 was to explore factors that influence adherence of patients on ART in order to develop ART intervention programmes. This review followed a systems approach. A social-ecological framework was used for the exploration of barriers and facilitators to sustained treatment adherence of persons on ART. In article 2 a literature study was done on the role of the community caregiver in the lives of persons on ART. This literature review explored the value of social support from the community caregiver regarding patients' adherence. This article applied the systems theory with a focus on the patient on ART, and the community caregiver. The literature review focused on the role of the community caregiver in antiretroviral treatment programmes; empowerment programmes for community caregivers; and made recommendations with regard to the role of the community caregiver during antiretroviral treatment in context of the information, motivation and behavioural skills model. Article 3 aimed to explore and describe the perceptions of community caregivers with regard to patients' ART adherence and a social work empowerment programme to enhance their skills to facilitate the adherence of HIV and AIDS patients on ART. This study used a qualitative approach with a phenomenological design. Focus group discussions were facilitated with sixteen community caregivers to gain insights into patients and ART adherence and a social work empowerment programme. The results of these focus group discussions assisted with the development of the social work empowerment programme. Article 4 focused on designing a social work empowerment programme for community caregivers. The literature and qualitative needs assessment identified many psychosocial challenges regarding patients' adherence to ART that was used for the design of the programme. Identified social workers participated in a peer review to evaluate the programme. In Article 4, an outline was given of the social work empowerment programme and the key elements of the programme were described, focussing on aspects of the implementation and facilitation of the programme. The aim of article 5 was to implement and evaluate the effectiveness of the social work empowerment programme. For the purpose of this study, experimental and comparison groups were formed comprising of twelve caregivers each. The comparison group received both the pre-test, post-test and post-post-test at the same time as the experimental group, but did not receive the treatment. The effectiveness of the programme was evaluated by means of the Personal Multi-Screening Inventory (PMSI). Evaluation according to this measuring scale took place on three occasions: before the group started, at the end of the last group session and one month after the last group session. The research indicated that the community caregivers were empowered through the programme and that such an empowerment programme is needed. Section C focuses on the conclusions and recommendations regarding the investigation. Section D consists of the combined references and section E consists of the annexures for the study.