PAPER: “Bidan cantik”: Psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center

“Bidan cantik”: Psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center

Andrian Liema,b,∗, Maria G. Adiyanti a

Reference:

Liem, A., & Adiyanti, M. G. (2013). “Bidan cantik”: Psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center. HIV & AIDS Review, 12(1), 14-22.

My Summary:

It is challenging to have a friendly midwives as the core door for HIV screening for PMTCT service. Learning from this experiemental studies-'Psychoeducation on HIV and AIDS among BIDAN CANTIK may increase the level knowledge of HIV among midwives, unfortunately, it may not significantly increase  a friendly attitude towards HIV-positive pregnant women. some social-cultural factors may contributed to this challenging, like "lack of midwives confidence and action about their knowledge related to HIV, and high stigma surrounding HIV within society may discourage them to spread the information about HIV> 

Abstract

Background

Midwives play a significant role in preventing HIV transfusion from mother to child since they directly deal with prospective mothers and pregnant women. However, it is considered that the quality services of midwives have not met the maximum standards.

Aim

To improve the quality service of midwives stationed at public health center through psychoeducation on HIV and AIDS based on Safer practices-Available Medication-VCT-Empowerment (SAVE) approach, referred to “ BIDAN Cerdas dan Empatik (CANTIK) ” program (Smart and Emphatic Midwives program).

Materials and methods

Action research with quasi experiment method using non-random untreated control group design with dependent pretest and posttest samples. The participants were 24 midwives working at public health center. The research instruments used were HIV knowledge test, negative attitude towards HIV scale, emphatic and caring consultation (ECC) observation sheet, and HIV socialization. Quantitative analysis was conducted through mixed design ANOVA and qualitative analysis was conducted in the form of narrative description.

Results and conclusion

BIDAN CANTIK psychoeducation program might improve the quality service of midwives at public health center. It was due to the improvement of knowledge on HIV. However, BIDAN CANTIK psychoeducation program did not significantly decrease negative attitude towards HIV and improve ECC. BIDAN CANTIK psychoeducation program was not succeeded in encouraging midwives to socialize HIV and AIDS to the patients of Health of Mother and Children Polyclinic. One of the obstacles in reducing negative attitude of midwives and in encouraging them to socialize HIV and AIDS was socio-cultural factor.

Some important quotation:

“Before training I was very afraid with HIV or AIDS but after this program I realized that things were not scary me anymore because I know how HIV spreading deeper and more detail.” (Midwife En)

“It turns out that compared to other diseases, HIV was not as scary as I thought all this time.” (Midwife S)

However, the most useful material according to the midwives was the modes of transmission of HIV because before the training they were very afraid of the infection. After knowing how HIV can and cannot be transmitted their fear subsided. Moreover, the most favorite material among the midwives was the topic of prevention because it related to the transmission of HIV, even more because of the nature of participants’ occupation as health workers which has a high risk of HIV infection. Some of the participants did not really like the material on ARV medicines because they thought it was difficult to memorize the types and they felt that it was not within their authority to assign medicines.

Conclusions

The results of this research showed that BIDAN CANTIK psychoeducation could help improve the service of public health center’s midwives. The service of midwives was improved through the significant increase of knowledge on HIV. However, BIDAN CANTIK was not significant in decreasing (negative) attitude toward HIV and increasing ECC. BIDAN CANTIK also could not encourage the midwives to socialize HIV and AIDS to HMC policlinic’s patients. This happened because of social-culture factor such as: (1) the midwives did not have confidence in their knowledge, even though that knowledge was accurate; (2) the midwives did not know how to take action based on the possessed knowledge; (3) the growing stigma within the society discouraged the midwives in spreading information on HIV and AIDS. Moreover, as an alternative model that had been newly implemented with small and non-randomized subjects, the effectiveness of BIDAN CANTIK cannot be generalized widely yet and has limitation on experiment validity.

Recommendations

 6.1. For midwives of PHC BIDAN CANTIK psychoeducation can be used to improve midwives knowledge on HIV and AIDS but it is need to practice and apply itto a daily basis so they can always remember the procedure. BIDAN CANTIK can be used as an alternative procedure reference in dealing with HMCP’s patients who are suspected to be HIV-positive. 6.2. For psychologist Psychologists can help midwives in showing less negative attitude and increased empathy toward HIV orientation to them. Pp 20-21

a. BIDAN CANTIK psychoeducation can reduce midwives’ negative attitude toward HIV and AIDS. However, for significant decrease, holding discussions with HIV-infected patients as well as HIVinfected and HIV-exposed health workers can be tried.

b. The changes in knowledge and attitude alone are not enough to push for HIV and AIDS socialization from PHC’ midwives to HMC policlinic’s patients. It is necessary to add more materials or special sessions to create follow-up action plan that they can use with the involvement of the community or villagers.

c. To increasing internal validity is necessary to conduct randomized selection and smaller range of subjects’ age to avoid the maturation.

d. To increasing construct validity is necessary to conduct quantitative manipulation check, in example presenting two raters to scoring congruity between program’s blue print and what facilitator explain.

e. To increasing external validity is necessary to conduct this program in various setting, in example between midwives of rural PHC and urban PHC.

2

Material and methods- pp 15-16

2.1

Participants

Participants in the study were 12 midwives stationed at Prambanan PHC as experiment group and 12 midwives stationed at Kalasan PHC as control group. Both PHC were in Sleman District and were chosen using non randomized method since they had more midwives than other PHC in Sleman. Inclusion criteria of participants were midwife who had graduated from Midwifery Program and worked at PHC. Meanwhile, exclusion criteria of participants were midwife who had patients, friends, or relatives who were infected with HIV; was not studying at university for undergraduate degree or higher; had not attended training or seminar about HIV and AIDS within the last year.

2.2

Research instruments

2.2.1

Knowledge on HIV and AIDS test

The purpose of the test was to measure the level of knowledge on HIV and AIDS of midwives, it was developed based on previous studies [43639424344 containing aspects which were as followed: general knowledge, causes, modes of transmission, symptoms of HIV and AIDS, treatment and medicine. There were 40 items on the test with “Right” or “Wrong” choices of answers. The result of try out on 43 respondents showed reliability score of 0.92.

2.2.2

Negative attitude scale towards HIV

The purpose of the instrument was to reveal negative attitude of midwives towards HIV and people living with HIV. There are 41 items with four alternative responses starting from “very agree” to “very disagree”, and it was developed based on the previous studies[424546] . The scale was divided into three parts with aspects: social isolation, discrimination, fairness, stigmatized midwives, blaming, compelling to do VCT, and comfortable contact. The result of try out on 43 respondents showed reliability score of 0.89.

2.2.3

Emphatic and caring consultation (ECC) observation sheet

ECC observation sheet was used to observe communication between midwives and their patients in HMCP during consultation [47] with indicators as followed: skill to pay attention to interlocutor and basic listening skill.

2.2.4

Socialization on HIV and AIDS observation sheet

The purpose of the sheet was to observe the socialization process, which was information delivery from midwives to patients at HMCP during consultation which included: modes of transmission, general preventive measures, characteristics and symptoms of HIV and AIDS, PMTCT of HIV, treatment and medicine, VCT of HIV. Observers checked on the checklist of behavior, which contained two responses: “Not explained” and “Explained”. It was developed based on the study conducted by Gamazina et al. [38] .

2.2.5

Psychoeducation evaluation sheet

It was used to evaluate the psychoeducation program given to midwives which included purpose, process, method, supporting environment, facilitator, and content [47] . The model used was reaction evaluation, which included: whether participants liked the program, whether participants felt that there were materials in the program which were irrelevant to daily life or profession.

2.2.6

Research design

The study was an action research, which was a study to solve targeted group's problem by taking advantage of collaboration between researcher and targeted group. Action research was consisted of several stages [48] which were as followed: assessment, diagnosis, designing intervention, intervention, quantitative evaluation on the output, reflection, and providing conclusion and suggestion as a repeated cycles.

2.2.7

Intervention

Intervention used was quasi experimental method using non random untreated control group design with dependent pretest and posttest samples so that the effectiveness and designed alternative model of intervention were able to be proven [49] ( Table 1 ). 

Table 1

Intervention design.

Group	Pretest	Treatment	Posttest	Follow-up
Experiment (EG)	O 1	X	O 2	O 3
Control (CG)	O 1		O 2	O 3

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Note . EG = midwives of Prambanan PHC; CG = midwives of Kalasan PHC; O ₁ = pretest: knowledge on HIV and AIDS test, negative attitude scale towards HIV, ECC observation, and socialization on HIV and AIDS observation; O ₂ = pretest: knowledge on HIV and AIDS test, negative attitude scale towards HIV, ECC observation, and socialization on HIV and AIDS observation; X = treatment BIDAN CANTIK; O ₃ = follow-up: knowledge on HIV and AIDS test, negative attitude scale towards HIV, and FGD to evaluate program. ECC observation, and socialization on HIV and AIDS observation do not repeated to minimalized patients’ uncomfortable.

Intervention given was a form of HIV and AIDS psychoeducation referred to as “ BIDAN CANTIK” which included scope of materials as followed: causes, modes of transmission, symptoms, prevention, HIV and AIDS care, HIV counseling, VCT, and active listening skill. It was conducted for four meeting after service hours of midwives at PHC, guided by a facilitator and co-facilitator, and was observed by observers with qualifications as followed:

·       a. Facilitator was a VCT counselor with more than five years experience, was working at health service line of work, have experiences in providing HIV and AIDS psychoeducation for health workers.

·       b. Co-facilitator was an undergraduate or students of Master Program of Psychology with experience of providing HIV and AIDS psychoeducation.

·       c.  Observer was an undergraduate or students of Master Program of Psychology with experience of conducting observation on individual and group.

2.3 Analysis

Data collected was analyzed quantitatively and qualitatively. Statistical test was also performed using mixed design ANOVA [50] and qualitative analysis was conducted in the form of narrative description of the results of observation, interview, FGD, and participants’ response on evaluation sheets.