Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners’ attitudes and practices in low-income countries

Figures & data

Figure 1. Baldwin and Ford’s transfer of training model (1988).

Table 1. Trainees’ baseline characteristics (N = 107).

		n (%)
Gender	Male	40 (37.4)
	Female	67 (62.6)
Age	Less or equal to 40 years	62 (57.9)
	40 year or more	45 (42.1)
Education	High school	8 (7.5)
	Bachelors	51 (47.7)
	Masters	40 (37.4)
	PhD	8 (7.5)
Working with SRHR	7 years or less	64 (59.8)
	8 years or more	43 (40.2)
Importance of religion	Yes	95 (88.8)
	No	12 (11.2)
Importance of culture	Yes	74 (69.2)
	No	32 (29.9)
	Missing	1 (0.9)
Influence of religion	Yes	48 (44.9)
	No	59 (55.1)
Influence of culture	Yes	44 (28.0)
	No	77 (72.0)
SRHR self-rated knowledge	Low (≤ mean)	55 (51.4)
	High (> mean)	52 (48.6)
Area of operation	Local level	20 (18.7)
	Intermediate	14 (13.1)
	National	71 (66.4)
	Missing	2 (1.9)
Employment level	Officers and managers	37 (34.6)
	Service providers	69 (64.5)
	Missing	1 (0.9)
Employment sector	Public sector	61 (57.0)
	Private sector	46 (43.0)

Table 2. Comparing trainees’ pre- and post-training scores for SRHR self-rated knowledge, SRHR attitudes, SRHR knowledge seeking behaviour and SRHR practices using paired samples t-test (N = 107).

Outcome variables	Measurement	Minimum-Maximum	Mean (SD)	t-value	Significance (P-value)
SRHR self-rated knowledge scores	Pre-training	10–40	27.7 (4.9)	11.9	<0.001
	Post- training	23–40	33.4 (3.9)
SRHR attitudes scores	Pre- training	16–35	29.9 (3.7)	6.6	<0.001
	Post- training	21–35	32.4 (2.8)
SRHR knowledge seeking behaviour scores	Pre- training	11–40	24.8 (6.6)	7.6	<0.001
	Post- training	10–40	30.1 (8.2)
SRHR practices scores	Pre- training	2–35	16.7 (7.8)	6.0	<0.001
	Post- training	2–35	20.4 (8.4)

The t-value (score) is the ratio between the difference between groups and the difference within the groups. A large t-value suggests that the groups are different, and a smaller t-value indicates more similarity between the two sample sets being compared.

Table 3. Comparing trainees’ delta scores in SRHR self-rated knowledge, SRHR attitudes, SRHR knowledge seeking behaviour and SRHR practices according to their baseline scores by independent samples t-test (N = 107).

Baseline scores*		Mean delta scores (SD)	t-value	Significance (P-value)
SRHR self-rated knowledge scores^1	≤Mean	6.1(7.5)	0.2	0.85
	>Mean	5.8 (4.3)
SRHR attitudes^2 scores	≤Mean	6.5 (5.3)	3.3	0.001
	>Mean	3.0 (2.4)
SRHR knowledge seeking behaviour^3	≤Mean	6.2 (7.5)	0.2	0.85
	>Mean	5.8 (4.3)
SRHR practices^4	≤Mean	5.9 (7.0)	2.7	0.009
	>Mean	2.4 (5.7)

The t-value is the ratio between the difference between groups and the difference within the groups. A large t-value suggests that the groups are different, and a smaller t-value indicates more similarity between the two sample sets being compared.

*Trainees with maximum scores at baseline were excluded from analysis (i.e. all cases with maximum score minus the mean delta score for the ‘low-baseline group’ for each scale were excluded).

¹excluded cases = 14.

²excluded cases = 52.

³excluded cases = 14.

⁴excluded cases = 8.

Table 4. Association between trainees’ baseline characteristics and changes in SRHR attitudes, SRHR knowledge seeking behaviour and SRHR practices by bivariate linear regression (N = 107).

	SRHR attitudes delta scores	SRHR knowledge seeking behaviour delta scores	SRHR practices delta scores
	B (95% CI)	B (95% CI)	B (95% CI)
No religious influence (Ref: Influence)	−1.05 (−2.50–0.39)	−0.15 (−2.92–2.62)	1.22 (−1.28–3.73)
No cultural influence (Ref: Influence)	0.05 (−1.42–1.53)	1.50 (−1.28–4.29)	1.39 (−1.13–3.92)
Age (Ref: 41 years or more)	−0.18 (−1.66–1.28)	0.49 (−2.30–3.28)	−.42 (−2.95–2.11)
Gender (Ref: Female)	0.27 (−1.23–1.77)	−0.81 (−3.65–2.04)	−2.03 (−4.59–.53)
SRHR self-rated knowledge (Ref: Low)	0.22 (0.36–0.07)**	−0.19 (−0.48–0.08)	.09 (−.16–.34)
Education (Ref: Bachelor’s or less)	−0.08 (−1.54–1.38)	0.26 (−2.51–3.04)	.46 (−2.05–2.98)
Working years (Ref: Less than 7 years)	−0.74 (−2.22–0.73)	0.71 (−2.09–3.52)	−1.84 (−4.37–.68)
Service providers Ref: officers/managers	0.35 (−0.39–1.09)	0.16 (−1.25–1.58)	1.64 (−.99–4.27)
Public sector employment (Ref: Private sector)	−0.35 (−1.82–1.11)	−2.45 (−5.20–0.29)	−.29 (−2.82–2.23)

Note. B=Unstandardised coefficient, P-value=**<0.01.

Table 5. Association between influence of religion, influence of culture and changes in SRHR attitudes, SRHR knowledge seeking behaviour and SRHR practices adjusted for other baseline characteristics by multiple linear regression (N = 107).

	SRHR attitudes delta scores			SRHR knowledge seeking behaviour delta scores			SRHR practices delta scores
	Model 1 B (95% CI)	Model 2 B (95% CI)	Model 3 B (95% CI)	Model 1 B (95% CI)	Model 2 B (95% CI)	Model 3 B (95% CI)	Model 1 B (95% CI)	Model 2 B (95% CI)	Model 3 B (95% CI)
No religious influence (Ref: Influence)	−1.26 (−2.85 0.31)	−1.30 (−2.91–0.30)	−0.97 (−2.57–0.63)	−0.86 (−3.87–2.14)	−0.81 (−3.86–2.24)	−0.62 (−3.76–2.51)	0.86 (−1.92–3.53)	1.05 (−1.67–3.79)	1.17 (−1.63–3.98)
No cultural influence (Ref: Influence)	0.56 (−1.04–2.16)	0.56 (−1.05–2.17)	0.60 −0.97–2.18)	1.84 (−1.19–4.88)	1.84 (−1.22–4.91)	1.99 (−1.09–5.08)	1.07 (−1.68–3.83)	1.11 (−1.63–3.86)	0.79 (−2.00–3.59)
Age (Ref: 41 years or more)	-	−0.19 (−1.69–1.31)	−0.19 (−1.72–1.33)	-	0.63 (−2.24–3.49)	0.26 (−2.73–3.27)	-	−0.16 (−2.73–2.41)	1.88 (−2.51–2.89)
Gender (Ref: Female)	-	0.43 (−1.11–1.98)	0.14 (−1.39–1.66)	-	−0.94 (−3.87–1.99)	−1.22 (−4.22–1.77)	-	−2.20 (−4.83–0.43)	−2.22 (−4.91–0.47)
SRHR self-rated knowledge (Ref: Low)		-	0.21** (0.35–0.05)		-	−0.22 (−0.52–0.07)		-	0.04 (−0.23–0.30
Education (Ref: Bachelor’s or less)		-	0.16 (−1.31–1.64)		-	0.38 (−2.51–3.27)		-	−1.25 (−3.98–1.47)
Working years (Ref: Less than 7 years)		-	−0.61 (−0.21–0.89)		-	0.78 (−2.15–3.73)		-	−1.75 (−4.43–0.92)

B=Unstandardised coefficient, P-value=**<0.01.

Model 1. Adjusted for influence of religion and influence of culture.

Model 2. Adjusted for model 1 plus age and gender.

Model 3. Adjusted for model 1 and model 2 plus, SRHR self-rated knowledge, education level and working years with SRHR.

Table 6. Association between changes in SRHR self-rated knowledge, changes in SRHR attitudes and changes in SRHR practices adjusted for change in SRHR knowledge seeking behaviour and other covariates by multiple linear regression (N = 107).

	SRHR practices delta scores
	Model 1 B (95% CI)	Model 2 B (95% CI)	Model 3 B (95% CI)
SRHR self-rated knowledge (Ref: low delta scores)	−0.01 (−0.26–0.25)	−0.01 (−0.26–0.24)	0.13 (−0.24–0.27)
SRHR attitudes (Ref: low delta scores)	0.22 (−0.12–0.55)	0.20 −0.13–0.53)	0.22 (−0.12–0.56)
SRHR knowledge seeking behaviour (Ref: low delta scores)	0.28 (0.11–0.46)**	0.28 (0.11–0.46)**	0.28 (0.10–0.0.46)**
Age (Ref: 41 years or more)	-	0.23 (−2.29–2.73)	−0.34 (−2.94–2.25)
Gender (Ref: Female)	-	−1.82 (−4.29–0.65)	−1.77 (−4.31–0.78)
8 years or more working years (Ref: Less than 7 years)	-	−1.88 −4.35–0.59)	−1.99 (−4.47–0.49)
No religious influence (Ref: Influence)	-	-	1.55 (−1.08–4.19)
No cultural influence (Ref: Influence)	-	-	0.53 (−2.10–3.16)
Service providers (Ref: Officers and managers)	-	-	1.76 (−0.89–4.40)

B=Unstandardised coefficient, P-value=* <0.05, **<0.01, ***< 0.001.

Model 1. Adjusted for SRHR self-rated knowledge, SRHR attitudes, knowledge seeking behaviour delta scores.

Model 2. Adjusted for model 1 plus age and gender.

Model 3. Adjusted for model 1 and model 2 plus influence of religion, influence of culture, level of employment.