Assessing the need for an online decision-support tool to promote evidence-based practices of psychosocial counseling in HIV care

Abstract

Psychosocial counselors have a vital and challenging role in supporting persons living with HIV/AIDS (PLWH/A) to better manage their disease. However, gaps in training, education, and skills limit the effectiveness of counselors’ efforts. We propose that the use of a decision-support tool for counselors at the point of care can support them in their work as well as help alleviate many training and practice gaps. Decision-support tools aimed at reducing knowledge and practice gaps are used extensively to assist clinical providers at the point of care; however, there is a need for decision-support tools designed specifically for HIV/AIDS counselors. To identify requirements for such a tool, we conducted a needs assessment through interviews of 19 HIV/AIDS clinic counselors who provide 20 or more hours per week of psychosocial support to PLWH/A. The assessment explored their education and training backgrounds, the extent to which evidence-based practices are implemented, and how a decision-support tool can support counselor work practices. Qualitative analysis was organized around seven main categories: counselor characteristics, patient characteristics, barriers, definitions of key concepts, use of guidelines, client assessments, and resources. The resulting coding schemes revealed knowledge and practice gaps among the interviewees, as well as barriers and challenges of counseling. Education and training background of the counseling staff varied widely. When asked to define five key concepts related to HIV counseling, 26–47% of respondents were unable to articulate an adequate definition. Less than half of the interviewees recalled sources of guidelines used in their work and specific models of care introduced during trainings. Interviews identified environmental barriers, language and literacy, patient education, and patient communication as the most prominent challenges to counseling work. The results from this study inform the need for and development of a decision-support tool to support the training and practices of HIV/AIDS counselors.

Keywords:

• HIV care
• decision-support system
• evidence-based medicine
• counseling
• needs assessment

Acknowledgements

The survey conducted in this study was funded in part by The Center for Interdisciplinary Research on Antimicrobial Resistance, CIRAR, http://www.cumc.columbia.edu/dept/nursing/CIRAR/, funded by The National Center for Research Resources, P20 RR020616. The research team expresses thanks to Peter Messeri, the Principal Investigator of the HIV TIPS project, all the participants in this study, and the AIDS Education and Training Center. Connie Chan is supported by NLM predoctoral fellowship T15-LM007079.