Lay HIV counselors’ knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique

Frontiers in Public Health, Volume 10, Year 2022

Interprétation

Introduction: Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods: We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results: The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion: Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy. This study was a mixed-methods cross-sectional study investigating knowledge and attitudes among lay HIV counselors in Mozambique toward depression. Between April and November 2019, we randomly selected 13 primary health care centers from two provinces: six in Maputo Province and seven in Maputo city, and invited all HIV counselors to participate. This yielded a convenience sample of 107 providers (93.04% response rate). We considered the following eligibility criteria: currently working as a lay HIV counselor at primary care health centers (HIV, TB, Maternal and Child Health), having been a lay HIV counselor for more than 3 months, and providing written informed consent to participate in the study. Participants provided basic information about their clinical background as well as sociodemographic information, including age, sex, education, marital status, type of counselor, years of counseling experience, and whether they had prior training in managing mental health problems. A research assistant administered the Depression Attitudes Questionnaire (DAQ) (43). We chose the DAQ because it was relevant to the research question, available in Portuguese, and culturally adaptable to Mozambique context. The DAQ includes 20 statements with 5-point Likert Scale response options ranging from strongly agree to strongly disagree. For the analysis, we collapsed the 5-point Likert scale responses to 3 points “disagree”; “neutral” and “agree.” The 20 statements/questions are grouped into three domains. The three domains include: nature of depression (nine items: Q1, Q2, Q4, Q5, Q6, Q7, Q8, Q10 and Q11); treatment of depression (eight items: Q3, Q12, Q14, Q16, Q17, Q18, Q19, and Q20), and professional attitudes (three items: Q9, Q13 and Q15). The domain “nature of depression” corresponded to depression risk factors and clinical features (44). The “treatment of depression” domain describes the treatment orientation and confidence in types of treatment, and the “professional reaction” domain is the professional confidence and ease in managing the needs of depressed patients (45). After completing the DAQ, each participant was asked a brief set of open-ended qualitative questions to further explore participants knowledge about diagnosis, symptoms, related risk factors, management and prevention of depression. These follow up questions were structured around the three domains of the DAQ, in order to further elucidate the participants’ perspectives on these topics. For the first domain, “nature of depression,” after administering the series of structured questions from the DAQ, we asked providers to use their own words to define depression, the common symptoms, and the perceived risk factors. We also asked specifically whether they considered HIV and AIDS to be a risk factor for depression, as well as to identify barriers to mental health treatment among people with HIV. For the second domain, “treatment of depression,” after asking their agreement to various statements about treatment alternatives for depression from the DAQ, we asked participants to use their own words to describe the types of depression treatment available locally, and where the services were provided. For the third domain, “professional attitudes,” we asked counselors to describe in their own words how they help patients with depression, and if they knew of any strategies to prevent depression in people with and without HIV. The qualitative interviews were recorded and then transcribed by the research assistants. The researcher revised each transcript to verify the accuracy of the data. After transcription of the interview, the voice records were stored on a password-protected computer, only accessed by the researcher. The average duration of each interview was 25 to 30 minutes. All interviews were conducted in Portuguese. All study procedures were reviewed and approved by the two Ethics Committees (from Federal University of São Paulo in Brazil and Eduardo Mondlane University in Mozambique). We used an explanatory QUANT = >QUAL sequential mixed-methods approach to data collection and analysis whereby the quantitative questions were asked first, and the qualitative questions were used to further explain and expand upon each domain (46, 47). For the quantitative data, we used frequency statistics to describe the distribution of demographic characteristics, training, and clinical experience in the sample for the quantitative data. We used Stata, Version 17 for the quantitative analysis. We also calculated the internal consistency of the three DAQ subscales using Cronbach’s alpha. For the qualitative data, we used software NVIVO version 10 to file and organize verbatim transcriptions of the interviews. We utilized a directed content analytic approach wherein we began analysis examining the three sub-domains of the DAQ and then broadened our analysis to include additional pre-defined topics (47). We thereafter quantified all qualitative data by coding, thematic analysis and describing patterns that emerged in the data (48, 49). All qualitative data were coded according to predominant themes identified by FM and LFG independently. The raters worked collaboratively to develop a taxonomy of the initial themes that emerged from the data. MCG and ACS supervised the coding and re-coding at different steps of this process to verify that findings were grounded in the data. Finally, we compared the qualitative responses by domain to the quantitative findings to help interpret those observations. When there was overall agreement in the sentiment of the qualitative statements and the quantitative findings, we had more confidence that questions were being understood in the correct way. When apparent contradictions emerged between the qualitative and quantitative data, we looked to the qualitative data to try to understand if those differences were real or if another explanation–such as the misunderstanding of one or more questions–could better explain the observations.

Résumé de l’IA

Study Justification:

– Depression is a common mental disorder among people living with HIV/AIDS and can negatively impact HIV treatment outcomes.
– Training lay HIV counselors to identify and manage depression can improve patient access and adherence to treatment, and reduce stigma and discrimination.
– This study aimed to assess the knowledge and attitudes of lay HIV counselors in Mozambique toward managing depression in primary care.

Highlights:

– The study used a mixed-methods cross-sectional design.
– Data was collected from 107 lay HIV counselors in 13 primary healthcare facilities in Mozambique.
– Findings suggested that HIV counselors had knowledge of depression and identified social support and psychotherapy as effective treatment approaches.
– Counselors found working with patients with depression to be rewarding.

Recommendations:

– Provide training and education for lay HIV counselors on identifying and managing depression.
– Strengthen social support systems for patients with depression, including involving trusted individuals and counseling services.
– Promote collaboration between HIV and mental health services to address the co-occurrence of HIV and depression.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation.
– Primary healthcare centers: Provide resources and support for training and education.
– NGOs and community-based organizations: Assist in implementing social support programs.
– Mental health professionals: Provide expertise and guidance in managing depression.

Cost Items:

– Training materials and resources for lay HIV counselors.
– Capacity-building workshops and seminars.
– Development and implementation of social support programs.
– Collaboration and coordination efforts between HIV and mental health services.
– Monitoring and evaluation of the effectiveness of interventions.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a mixed-methods cross-sectional study conducted in Mozambique. The study included a convenience sample of 107 lay HIV counselors from primary healthcare centers. The quantitative data was collected using the Depression Attitude Questionnaire (DAQ) scale, and the qualitative data was collected through open-ended questions. The study provides insights into the knowledge and attitudes of lay HIV counselors toward managing depression in primary care. However, the abstract does not provide specific details about the findings or the statistical analysis conducted. To improve the evidence, the abstract should include a summary of the key findings and the statistical analysis conducted, such as the frequencies and percentages of responses to the DAQ scale. Additionally, it would be helpful to mention any limitations of the study and suggestions for future research.

Abstrait

This study was a mixed-methods cross-sectional study investigating knowledge and attitudes among lay HIV counselors in Mozambique toward depression. Between April and November 2019, we randomly selected 13 primary health care centers from two provinces: six in Maputo Province and seven in Maputo city, and invited all HIV counselors to participate. This yielded a convenience sample of 107 providers (93.04% response rate). We considered the following eligibility criteria: currently working as a lay HIV counselor at primary care health centers (HIV, TB, Maternal and Child Health), having been a lay HIV counselor for more than 3 months, and providing written informed consent to participate in the study. Participants provided basic information about their clinical background as well as sociodemographic information, including age, sex, education, marital status, type of counselor, years of counseling experience, and whether they had prior training in managing mental health problems. A research assistant administered the Depression Attitudes Questionnaire (DAQ) (43). We chose the DAQ because it was relevant to the research question, available in Portuguese, and culturally adaptable to Mozambique context. The DAQ includes 20 statements with 5-point Likert Scale response options ranging from strongly agree to strongly disagree. For the analysis, we collapsed the 5-point Likert scale responses to 3 points “disagree”; “neutral” and “agree.” The 20 statements/questions are grouped into three domains. The three domains include: nature of depression (nine items: Q1, Q2, Q4, Q5, Q6, Q7, Q8, Q10 and Q11); treatment of depression (eight items: Q3, Q12, Q14, Q16, Q17, Q18, Q19, and Q20), and professional attitudes (three items: Q9, Q13 and Q15). The domain “nature of depression” corresponded to depression risk factors and clinical features (44). The “treatment of depression” domain describes the treatment orientation and confidence in types of treatment, and the “professional reaction” domain is the professional confidence and ease in managing the needs of depressed patients (45). After completing the DAQ, each participant was asked a brief set of open-ended qualitative questions to further explore participants knowledge about diagnosis, symptoms, related risk factors, management and prevention of depression. These follow up questions were structured around the three domains of the DAQ, in order to further elucidate the participants’ perspectives on these topics. For the first domain, “nature of depression,” after administering the series of structured questions from the DAQ, we asked providers to use their own words to define depression, the common symptoms, and the perceived risk factors. We also asked specifically whether they considered HIV and AIDS to be a risk factor for depression, as well as to identify barriers to mental health treatment among people with HIV. For the second domain, “treatment of depression,” after asking their agreement to various statements about treatment alternatives for depression from the DAQ, we asked participants to use their own words to describe the types of depression treatment available locally, and where the services were provided. For the third domain, “professional attitudes,” we asked counselors to describe in their own words how they help patients with depression, and if they knew of any strategies to prevent depression in people with and without HIV. The qualitative interviews were recorded and then transcribed by the research assistants. The researcher revised each transcript to verify the accuracy of the data. After transcription of the interview, the voice records were stored on a password-protected computer, only accessed by the researcher. The average duration of each interview was 25 to 30 minutes. All interviews were conducted in Portuguese. All study procedures were reviewed and approved by the two Ethics Committees (from Federal University of São Paulo in Brazil and Eduardo Mondlane University in Mozambique). We used an explanatory QUANT = >QUAL sequential mixed-methods approach to data collection and analysis whereby the quantitative questions were asked first, and the qualitative questions were used to further explain and expand upon each domain (46, 47). For the quantitative data, we used frequency statistics to describe the distribution of demographic characteristics, training, and clinical experience in the sample for the quantitative data. We used Stata, Version 17 for the quantitative analysis. We also calculated the internal consistency of the three DAQ subscales using Cronbach’s alpha. For the qualitative data, we used software NVIVO version 10 to file and organize verbatim transcriptions of the interviews. We utilized a directed content analytic approach wherein we began analysis examining the three sub-domains of the DAQ and then broadened our analysis to include additional pre-defined topics (47). We thereafter quantified all qualitative data by coding, thematic analysis and describing patterns that emerged in the data (48, 49). All qualitative data were coded according to predominant themes identified by FM and LFG independently. The raters worked collaboratively to develop a taxonomy of the initial themes that emerged from the data. MCG and ACS supervised the coding and re-coding at different steps of this process to verify that findings were grounded in the data. Finally, we compared the qualitative responses by domain to the quantitative findings to help interpret those observations. When there was overall agreement in the sentiment of the qualitative statements and the quantitative findings, we had more confidence that questions were being understood in the correct way. When apparent contradictions emerged between the qualitative and quantitative data, we looked to the qualitative data to try to understand if those differences were real or if another explanation–such as the misunderstanding of one or more questions–could better explain the observations.

Matériaux

N/A

Innovations

The study mentioned in the description is titled “Lay HIV counselors’ knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique.” The purpose of the study was to assess the knowledge and attitudes of lay HIV counselors in Mozambique regarding the management of depression in primary care. The study used a mixed-methods approach, combining quantitative data from the Depression Attitude Questionnaire (DAQ) with qualitative interviews.

The study randomly selected 13 primary healthcare centers in Mozambique and invited all HIV counselors to participate. A total of 107 lay HIV counselors participated in the study. The eligibility criteria included currently working as a lay HIV counselor at primary care health centers, having been a lay HIV counselor for more than 3 months, and providing written informed consent.

The quantitative data was collected using the DAQ, which consists of 20 statements with 5-point Likert scale response options. The statements were grouped into three domains: nature of depression, treatment of depression, and professional attitudes. The responses were analyzed using frequency statistics and Cronbach’s alpha was calculated to assess the internal consistency of the three DAQ subscales.

After completing the DAQ, participants were asked open-ended qualitative questions to further explore their knowledge about depression. The qualitative interviews were recorded, transcribed, and analyzed using a directed content analytic approach. Predominant themes were identified and patterns in the data were described.

The study found that lay HIV counselors in Mozambique had some knowledge of depression and identified HIV and psychosocial issues as key risk factors. They believed that the treatment approach should focus on social support and psychotherapy. The study also identified areas where further training and support for lay HIV counselors could be beneficial in managing depression in primary care.

Overall, the study provides insights into the knowledge and attitudes of lay HIV counselors in Mozambique regarding depression management and highlights the importance of addressing mental health issues in the context of HIV care.

AI Innovations Description

The study described is focused on assessing the knowledge and attitudes of lay HIV counselors in Mozambique towards managing depression in primary care. The researchers used a mixed-methods cross-sectional approach, combining quantitative and qualitative data collection methods.

The quantitative data was collected using the Depression Attitude Questionnaire (DAQ), which consists of 20 statements with 5-point Likert scale response options. The statements were grouped into three domains: nature of depression, treatment of depression, and professional attitudes. The participants, who were lay HIV counselors working in primary healthcare centers, provided their responses to the questionnaire.

The qualitative data was collected through open-ended questions that further explored the participants’ knowledge about depression, including its diagnosis, symptoms, risk factors, management, and prevention. The interviews were conducted in Portuguese, recorded, and transcribed for analysis.

The researchers used a sequential mixed-methods approach, where the quantitative data was analyzed first using frequency statistics and Cronbach’s alpha to assess internal consistency. The qualitative data was analyzed using NVIVO software for coding, thematic analysis, and identifying patterns.

The findings of the study indicated that the lay HIV counselors had some knowledge of depression and recognized it as a cluster of psychological symptoms. They identified talking to trusted people and counseling with a psychotherapist as effective ways for patients to deal with depression. The counselors also acknowledged the challenges but found working with patients with depression to be rewarding.

The study provides valuable insights into the knowledge and attitudes of lay HIV counselors towards depression in Mozambique. The findings can be used to inform the development of interventions and training programs to improve access to maternal health by addressing depression among pregnant women. For example, incorporating mental health training for lay health workers, including HIV counselors, can enhance their ability to identify and manage depression in pregnant women, leading to improved patient outcomes and reduced stigma and discrimination. Additionally, the study highlights the importance of social support and psychotherapy in the treatment approach for depression, which can be integrated into maternal health services to provide comprehensive care for pregnant women.

AI Innovations Methodology

The study described is a mixed-methods cross-sectional study that aimed to assess the knowledge and attitudes of lay HIV counselors in Mozambique toward managing depression in primary care. The study used both quantitative and qualitative data collection methods to gather information from the participants.

The methodology of the study involved randomly selecting 13 primary healthcare centers in Mozambique and inviting all HIV counselors to participate. The eligibility criteria included currently working as a lay HIV counselor at primary care health centers, having been a lay HIV counselor for more than 3 months, and providing written informed consent to participate.

The quantitative data collection involved administering the Depression Attitudes Questionnaire (DAQ) to the participants. The DAQ consists of 20 statements with 5-point Likert scale response options. The responses were collapsed into three categories: “disagree,” “neutral,” and “agree.” The statements were grouped into three domains: nature of depression, treatment of depression, and professional attitudes.

After completing the DAQ, the participants were asked a set of open-ended qualitative questions to further explore their knowledge about depression. The qualitative questions were structured around the three domains of the DAQ. The interviews were recorded, transcribed, and analyzed using a directed content analytic approach.

The quantitative data were analyzed using frequency statistics to describe the distribution of demographic characteristics, training, and clinical experience in the sample. The internal consistency of the three DAQ subscales was calculated using Cronbach’s alpha.

The qualitative data were analyzed using software NVIVO version 10 to organize and analyze the verbatim transcriptions of the interviews. A directed content analytic approach was used, and themes were identified by the researchers. The qualitative data were compared to the quantitative findings to help interpret the observations.

Overall, this study employed a mixed-methods approach to gather comprehensive data on the knowledge and attitudes of lay HIV counselors in Mozambique toward managing depression in primary care. The combination of quantitative and qualitative data provided a deeper understanding of the participants’ perspectives and allowed for a more comprehensive analysis of the research question.

Auteur

Dima Health

Identifiers:

DOI: 10.3389/fpubh.2022.919827

Research Areas:

Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Social Determinants

Study Countries:

Mozambique

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female

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