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Lukumay GG, Mushy SE, Mgopa LR, Mkoka DA, Massae AF, Mwakawanga DL, Rosser BRS, Kohli N, Rohloff CT, Ross MW, Trent M. Healthcare professional students' skills in sexual health communication and history taking: inter-rater reliability of standardized patients and faculty ratings in dar es Salaam, tanzania- a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:627. [PMID: 38840085 PMCID: PMC11155028 DOI: 10.1186/s12909-024-05607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Low- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students. METHODS We conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ). RESULTS A total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%). CONCLUSION The use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.
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Affiliation(s)
- Gift G Lukumay
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania.
| | - Stella Emmanuel Mushy
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Dickson Ally Mkoka
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - B R Simon Rosser
- University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Nidhi Kohli
- University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Corissa T Rohloff
- University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Michael W Ross
- University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Maria Trent
- Johns Hopkins University School of Medicine, 200 N. Wolfe Street, #2056, Baltimore, MD, 21287, USA
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Massae AF, Mgopa LR, Bonilla ZE, Mohammed I, Rosser BRS, Mushy SE, Ross MW, Mwakawanga DL, Mkonyi E, Lukumay GG, Wadley J, Mkoka DA, Trent M. Addressing sexual health concerns in Tanzania: perceived barriers among healthcare professionals and students in the "training for health professionals" study. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 38284804 DOI: 10.1080/13691058.2024.2306227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
Little is known about the factors that may prevent healthcare professionals as key stakeholders from exploring sexual health issues in Tanzania. This study examined healthcare professionals' perspectives on the barriers to addressing sexual health concerns in practice. In June 2019, we conducted an exploratory qualitative study involving 18 focus group discussions among healthcare professionals (n = 60) and students (n = 61) in the health professions (midwifery, nursing, medicine) in Dar es Salaam, Tanzania. Study participants and design were purposively selected and stratified. We used a focus group discussion guide in Kiswahili. Data were transcribed in Kiswahili and translated into English. A thematic analysis approach was used for data analysis. Two themes were developed: (1) differences between health care professional and patient socio-demographic characteristics; (2) health care system and patients' backgrounds, such as communication barriers, lack of confidentiality and privacy within health facilities, type of clinical presentation and complaint, patient behaviours, and their clinical background. Several key barriers prevented sexual health communication between healthcare professionals and patients, affecting the quality of sexual health service delivery. Additional sexual health clinical training is warranted for health professions students and professionals to optimise sexual health care delivery in a culturally conservative country like Tanzania.
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Affiliation(s)
- Agnes F Massae
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zobeida E Bonilla
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Inari Mohammed
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - B R Simon Rosser
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Stella E Mushy
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael W Ross
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Gift G Lukumay
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James Wadley
- Counseling and Human Services Department, Lincoln University, Philadelphia, PA, USA
| | - Dickson A Mkoka
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maria Trent
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
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Thomson J, Ross MW, van Deventer H, Poelsma M, Pienaar ME, du Toit M, Botha MH. Assessing comfort with sexuality-related questions in medical students: "a little discomfort is better than a lifetime of suffering in silence". Sex Med 2023; 11:qfad035. [PMID: 37448743 PMCID: PMC10336024 DOI: 10.1093/sexmed/qfad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background Sexual history-taking competence in medical students is an essential skill that they need to acquire. It requires them to learn to develop comfort in using sexuality-related language and raising the subject with patients. Sexual history exploration skills are inadequately taught in a significant number of medical schools. Aim We studied comfort levels in using sexuality-related language in medical students who had no training yet in history taking. Methods First-year medical students in a South African university engaged in an exercise in pairs-a dyad-alternating the role of interviewer and interviewee. Provided questions and answers were offered to the students, who videotaped their dyad interview and uploaded it to a safe university environment for peer review. Outcomes As part of the exercise, students rated their comfort in the interview for 35 questions on a 5-point Likert scale. Students then participated in online discussion forums with fellow students and tutors on their experience. Results Students posing the questions, the interviewers, were significantly more comfortable with the questions than interviewees. Total comfort scores over the 35 questions showed a roughly normal distribution for both. Questions with explicit sexual behavior or vocabulary were rated more uncomfortable by interviewers as well as interviewees. The total scores for interviewers showed a distribution with a longer tail toward discomfort. Female interviewees were significantly more uncomfortable than male interviewees, but this was not the case for interviewers. Dyads of 2 females were significantly more uncomfortable than mixed-gender and 2-male dyads. Qualitative data showed wide acceptance of the exercise by students, with increasing confidence and comfort in using sexually explicit terms in strong appreciation of the responder's perspective in the exercise, as well as awareness that receiving a question-the patient's position-is more uncomfortable. Clinical Translation Data indicate that comfort assessment in asking sexuality-related questions with expected different levels of comfort and discomfort is a valuable measure that can evaluate progress in this skill. The data also suggest the need for students to select profiles and questions to provide a trauma-informed approach, knowing that some of the medical students will have experienced sexually related trauma, as in the general population. Strengths and Limitations This study provides a method and student feedback in teaching sexual history elicitation and increasing comfort with sexual language in a clinical context. The study is limited to first-year medical students. Conclusion Histories with provided questions and answers allow for rating of comfort and provision of trauma-informed education in developing sexual history exploration clinical skills.
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Affiliation(s)
- Jantien Thomson
- Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa
| | | | - Heidi van Deventer
- Department of Urology, Stellenbosch University Medical School, Cape Town 7505, South Africa
| | - Mieke Poelsma
- Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa
| | - Marie E Pienaar
- Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa
| | - Marlena du Toit
- Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa
| | - Matthys H Botha
- Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa
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Ohanson NJ, Pretorius D. Compliance of medical practitioners with diabetic treatment guidelines in West Rand, Gauteng. S Afr Fam Pract (2004) 2023; 65:e1-e7. [PMID: 37042527 PMCID: PMC10091144 DOI: 10.4102/safp.v65i1.5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Diabetes mellitus is increasing globally and is associated with multiple complications. Guidelines have been formulated to standardise care among people living with diabetes mellitus (DM), but research shows poor compliance with treatment guidelines. The aim of this study was to assess how well healthcare practitioners in a district hospital in Gauteng complied with the most recent diabetic treatment guideline, Society for Endocrinology Metabolism and Diabetes South Africa (SEMDSA) 2017. METHODS A retrospective cross-sectional review of patient record living with diabetes was done. This study was conducted in the out-patient department of Dr Yusuf Dadoo hospital in the West Rand, Gauteng. A total of 323 records of patients seen from August 2019 to December 2019 were reviewed, and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017. RESULTS Files were audited in four categories: comorbidities, examinations, investigations and the presence of complications. Six monthly glycated haemoglobin (HbA1c) was assessed in 40 (12.4%), annual creatinine assessed in 179 (55.4%) and lipogram in 154 (47.7%) of patients. More than 70% of patients had uncontrolled glycaemia and two people were screened for erectile dysfunction. CONCLUSION Monitoring and control parameters were infrequently done as per guideline recommendations. The resultant effects were poor glycaemic control and thus numerous complications.Contribution: Targeted strategies to improve medical practitioner compliance to guidelines including further research to study factors associated with poor compliance with guidelines are needed to improve the overall care of people living with DM in the West Rand and thus minimise the risk of complications among patients in the district.
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Affiliation(s)
- Nneka J Ohanson
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Van Deventer H, Ross MW, Thomson J, Du Toit M, Poelsma M, Pienaar M, Van der Merwe A, Botha MH. The start of sexual health curriculum development and evaluation at Stellenbosch University. Afr J Prim Health Care Fam Med 2023; 15:e1-e9. [PMID: 37042540 PMCID: PMC10091179 DOI: 10.4102/phcfm.v15i1.3825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/14/2022] [Accepted: 01/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS), developed a sexual health course to be integrated throughout the revised medical curriculum. AIM To use the Sexual Health Education for Professionals Scale (SHEPS) to gather baseline and future follow-up data to inform curriculum development and evaluation. SETTING The first-year medical students (N = 289) of the FMHS SU. METHODS The SHEPS was answered before the start of the sexual health course. The knowledge, communication and attitude sections were answered with a Likert-type scale. Students had to describe their perceived confidence in their knowledge and communication skills to care for patients within specific sexuality-related clinical scenarios. The attitude section measured the students' level of agreement or disagreement on sexuality-related opinion statements. RESULTS The response rate was 97%. Most students were female, and 55% of the class were first taught about sexuality in the age group 13-18 years. The students had more confidence in their communication skills than knowledge before any tertiary training. The attitude section revealed a binomial distribution, ranging from acceptance to a more restrictive attitude towards sexual behaviour. CONCLUSION It is the first time the SHEPS has been used in a South African context. The results provide novel information about the range of perceived sexual health knowledge, skills and attitudes of first-year medical students before they start tertiary training.Contribution: Findings from this study will guide content development and evaluation of the sexual health course at the institution where the study was conducted, as well as allow for culture sensitive education.
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Affiliation(s)
- Heidi Van Deventer
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Pretorius D, Mlambo MG, Couper ID. Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [PMID: 35792630 PMCID: PMC9257710 DOI: 10.4102/phcfm.v14i1.3286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022] Open
Abstract
Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province.Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used.Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints.Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.
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Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Rosser BRS, Mkoka DA, Rohloff CT, Mgopa LR, Ross MW, Lukumay GG, Mohammed I, Massae AF, Mkonyi E, Mushy SE, Mwakawanga DL, Kohli N, Trent ME, Wadley J, Bonilla ZE. Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35695444 PMCID: PMC9210149 DOI: 10.4102/phcfm.v14i1.3434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health. AIM This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum. SETTING Healthcare settings in Tanzania. METHODS Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students). RESULTS Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines. CONCLUSION A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate.
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Affiliation(s)
- B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, United States of America.
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