Abstract：
BACKGROUND: Delays in the implementation of evidence-based practices are significant and ubiquitous, compromising health outcomes. Resistance to change is a key factor in hindering adoption and integration of new evidence-based interventions. This study seeks to understand the impact of exposure to HIV testing within a research context on provider attitudes towards HIV counselling and testing (HCT) in emergency departments (ED).
METHODS: This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention.
RESULTS: A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20-29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0-4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards \'the benefit of offering ED-based HCT to patients\' (4.33), \'the ED offering HCT\' (3.53), \'all ED patients receiving HCT\' (3.42), \'concern about patient reaction to HCT\' (3.26), and \'comfort with disclosing HCT results\' (3.21); and a mildly negative attitude towards \'only high-risk ED patients receiving HCT\' (2.68), and \'the burden of offering HCT in a clinical environment\' (2.80). Post-intervention, provider attitudes improved significantly towards \'all ED patients receiving HCT\' (3.86, p < 0.05), \'only high-risk ED patients receiving HCT\' (2.30, p < 0.05), \'the burden of offering HCT in a clinical environment\' (3.21, p < 0.05), and \'comfort with disclosing HCT results\' (3.81, p < 0.05).
CONCLUSIONS: Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.
METHODS: This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention.
RESULTS: A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20-29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0-4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards \'the benefit of offering ED-based HCT to patients\' (4.33), \'the ED offering HCT\' (3.53), \'all ED patients receiving HCT\' (3.42), \'concern about patient reaction to HCT\' (3.26), and \'comfort with disclosing HCT results\' (3.21); and a mildly negative attitude towards \'only high-risk ED patients receiving HCT\' (2.68), and \'the burden of offering HCT in a clinical environment\' (2.80). Post-intervention, provider attitudes improved significantly towards \'all ED patients receiving HCT\' (3.86, p < 0.05), \'only high-risk ED patients receiving HCT\' (2.30, p < 0.05), \'the burden of offering HCT in a clinical environment\' (3.21, p < 0.05), and \'comfort with disclosing HCT results\' (3.81, p < 0.05).
CONCLUSIONS: Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.
摘要：
背景：实施基于证据的实践的延迟是显着且普遍存在的，损害健康结果。抵制变革是阻碍采用和整合新的循证干预措施的关键因素。这项研究旨在了解在研究背景下暴露于HIV检测对提供者对急诊科（ED）HIV咨询和检测（HCT）的态度的影响。
方法：这是一项研究前后的设计，用于测量基于ED的新型HCT干预措施的效果。由外行顾问进行，关于东开普省提供者的态度，南非。一个经过验证的，匿名,7项调查由常规护理提供者自行完成(医生，护士,和案例经理)。问题以5分的李克特量表进行评分，其中5分始终反映出积极的态度。计算每个问题的平均分数，并使用双样本t检验进行比较，以评估干预前后接受调查的提供者态度的样本均值变化。
结果：在三个ED中完成了132项调查。大多数受访者是女性(70.5%)，20-29岁（37.9%），非洲种族（81.1%），护士(39.4%)，和行医0-4年(37.9%)。干预前,提供者对“向患者提供基于ED的HCT的好处”表现出积极态度（4.33），“ED提供HCT”（3.53），'所有接受HCT的ED患者'（3.42），“关注患者对HCT的反应”（3.26），和“对披露HCT结果的舒适度”（3.21）；以及对“仅接受HCT的高风险ED患者”的轻度消极态度（2.68），和“在临床环境中提供HCT的负担”（2.80）。干预后，提供者对接受HCT的所有ED患者的态度显着改善（3.86，p<0.05），\'仅接受HCT的高危ED患者\'（2.30，p<0.05），“在临床环境中提供HCT的负担”（3.21，p<0.05），和“对披露HCT结果的舒适度”（3.81，p<0.05）。
结论：对具有结构化实施期的新实践的受控暴露可以改变态度，开始实践规范化的过程。在我们的研究中,我们观察到提供者对HCT的益处以及向ED中所有患者提供HCT的负担的态度有所改善.研究活动可能在减轻对变革的抵制和支持干预措施的采用方面发挥作用。
方法：这是一项研究前后的设计，用于测量基于ED的新型HCT干预措施的效果。由外行顾问进行，关于东开普省提供者的态度，南非。一个经过验证的，匿名,7项调查由常规护理提供者自行完成(医生，护士,和案例经理)。问题以5分的李克特量表进行评分，其中5分始终反映出积极的态度。计算每个问题的平均分数，并使用双样本t检验进行比较，以评估干预前后接受调查的提供者态度的样本均值变化。
结果：在三个ED中完成了132项调查。大多数受访者是女性(70.5%)，20-29岁（37.9%），非洲种族（81.1%），护士(39.4%)，和行医0-4年(37.9%)。干预前,提供者对“向患者提供基于ED的HCT的好处”表现出积极态度（4.33），“ED提供HCT”（3.53），'所有接受HCT的ED患者'（3.42），“关注患者对HCT的反应”（3.26），和“对披露HCT结果的舒适度”（3.21）；以及对“仅接受HCT的高风险ED患者”的轻度消极态度（2.68），和“在临床环境中提供HCT的负担”（2.80）。干预后，提供者对接受HCT的所有ED患者的态度显着改善（3.86，p<0.05），\'仅接受HCT的高危ED患者\'（2.30，p<0.05），“在临床环境中提供HCT的负担”（3.21，p<0.05），和“对披露HCT结果的舒适度”（3.81，p<0.05）。
结论：对具有结构化实施期的新实践的受控暴露可以改变态度，开始实践规范化的过程。在我们的研究中,我们观察到提供者对HCT的益处以及向ED中所有患者提供HCT的负担的态度有所改善.研究活动可能在减轻对变革的抵制和支持干预措施的采用方面发挥作用。
