Advancing Nursing Leadership

Factors Predicting HIV-related Knowledge Among Urban Health Workers In Malawi Sri Yona,1 So Hyun Park,1 Jane L. Chimango,,2 Angela F. Chimwaza, 2, Chrissie. P. N. Kaponda,2 Kathleen F. Norr,1 James L. Norr1

1. University of Illinois at Chicago 2. Kamuzu College of Nursing, University of Malawi

BACKGROUND • Malawi is predominately rural and agricultural; 52.4% of

population lived below poverty in 2004 (World Bank, 2010)

• The national adult HIV prevalence rate is 11% and 800,000 Malawians are HIV positive (UNAIDS, 2010)

• Over 80% of new infections are due to sexual transmission

• Health workers need to know about HIV in order to prevent infection for themselves and their patients

SETTING AND SAMPLE

METHODSAnalyses• Mean scores for each knowledge index and correlations among the

four aspects of HIV-related knowledge were examined

• Multiple linear regressions were used to determine the impact of demographic and attitudinal variables on each of the four HIV-related knowledge measures

DISCUSSION

AND IMPLICATIONS• More effective HIV-related education for health workers is needed,

especially for lower level workers

• Because different aspects of HIV-related knowledge are not highly related, it is important to educate health workers regarding all aspects of HIV prevention

• Reducing stigmatizing attitudes toward PLWH may also contribute to improved HIV-related knowledge

• Future health worker training should include sexual prevention strategy knowledge and stigma reduction

ACKNOWLEDGEMENTS• National Institute of Health, National Institute of Nursing Research

(R01 NR08058, K. Norr PI)

• John Fogarty International Centre AIDS AITRP at UIC (D43TW001419) provided Sri Yona with support while doing this analysis

Multiple Linear Regression•Clinicians/technicians had significantly higher scores than lower level workers for all four areas of HIV-related knowledge. This was the only predictor related to all four areas of knowledge

•Blaming PLWHs was significantly related to lower knowledge of HIV transmission and STI knowledge

Table 2. Demographic and Attitudinal Factors Predicting HIV-Related Knowledge (multiple regression)

• This secondary analysis used baseline survey data for 366 urban health workers in a referral hospital

• All hospital workers were eligible, and were randomly selected from an employee list

• Job Type 51.4% clinical and technical workers

(MD, clinical officer, dentist, RN) 36.3% clinical support workers

(auxiliary nurse, patient attendant, community worker) 12.3% were non-clinical support workers

(administrators, clerks, guards, laundry workers ).

• Demographic Characteristics Education: 53% had primary school or less Marital Status: 75% currently married Age: 62% were over age 35

Dependent Variables: HIV-related knowledge1. Preventing sexual transmission: 1 item, scored as proportion mentioned

of 3 strategies (abstaining, being faithful, using condoms), range 0-1

2. HIV transmission: 6 items (e.g., a person can get HIV from a mosquito bite), scored as proportion correct, range 0-1

3. STI knowledge: 2 items (who needs to be treated, can have STI without knowing it), scored as proportion correct, range 0-1

4. UP knowledge: 22 items, 4 knowledge indices (gloves,15-items; hand washing, 3-items; sharp, 2-items; and cleaning, 2-items); scored as proportion correct, range 0-1

Africa

Table 1. Means and Correlations among HIV-related Knowledge

Means and Correlations•Health workers had the highest knowledge scores for HIV transmission (81% correct). Knowledge of sexual prevention strategies was lowest (65% correct)

•Correlations between HIV-related knowledge scores were relatively low. The highest correlation was between HIV transmission and STI knowledge (r = .29, p<.001)

Explanatory factors• Job type and demographic factors• Attitudinal factors

Condom attitudes: 10 items, scored % positive Blames a person living with HIV (PLWH) for getting infected: 1 item, no=1, don’t

know=2, yes=3, range 1-3 Accepts contact with PLWH: Mean score, 2 items (cook a meal, be in public places),

no=1, not sure=2, yes=3, range 1-3

PURPOSE• To identify health workers’ level of knowledge about:

HIV sexual transmission prevention strategies HIV transmission Sexually Transmitted Infections (STIs) Universal precautions (UP)

• To identify the demographic and attitudinal factors that predict each of the four aspects of HIV-related knowledge

* p <.05, ** p <.01

* p <.05, ** p <.01

RESULTS

Malawi

Hospital Facility

HIV/AIDS Services

Nurse Sterilizing Equipment

Consulting About a Client