8 HIV/AIDS Tool Kit C. Checklist for Implementing the HIV/AIDS Questionnaire for Health Care Providers and Staff
Checklist for Implementing the HIV/AIDS KAP Questionnaire for Health Care Providers and Staff The following instructions should help your organization effectively use the HIV/AIDS KAP Questionnaire for Health Care Providers and Staff. These steps cover the general approach to carrying out the questionnaire, from start to finish, and are intended for the person overseeing implementation of this questionnaire among staff. Overview Purpose of this Questionnaire: As you know, your organization is participating in an initiative to improve its services related to HIV/AIDS. The HIV/AIDS KAP Questionnaire for Health Care Providers and Staff will collect information about the knowledge and beliefs of staff, especially health care providers, regarding HIV/AIDS. The findings from this questionnaire can be used to guide future HIV programming and develop capacity-building materials, trainings, and programs for staff in order to improve health services related to HIV/AIDS. The comparison of baseline and endline results can also be used to approximate the effects of efforts taken to build staff capacity around HIV/AIDS. Pre-implementation instructions STEP 1: Familiarize Yourself with the Questionnaire The KAP survey is designed to be self-administered and completed confidentially by health care providers and other staff who agree to participate. You will likely need to field questions from participants about the KAP survey. Therefore, it is important to have completed the KAP survey yourself and be familiar with the questions before implementing it among staff. Note: only the core people responsible for implementing the questionnaire should review the questionnaire at this phase - all staff who will be participating in the questionnaire should not be involved in this phase. Your role is central to implementing the questionnaire, which is designed to be selfadministered (i.e. completed individually by each participant, with no assistance) and completed confidentially by staff members who agree to participate. Additionally, your role will include fielding any questions that participants have about the questionnaire. Therefore, it is important that you are familiar with the questionnaire and have completed it yourself before implementing it among staff (this will be part of the pre-test before implementation). Implementation Guide for the HIV/AIDS KAP Questionnaire 2
STEP 2: Adapting the Questionnaire to Fit the Local Context Make any necessary changes to the wording of the questionnaire so that it best reflects the local context. Verify that the questions are understandable and that the vocabulary and phrases in the questionnaire reflect the vocabulary and style of speech of staff members. On page one of the questionnaire, be sure to add specific information under Instructions to inform respondents about how to return the questionnaire once they have completed it. On page two of the questionnaire, be sure to replace the answer choices for question 2 to reflect the sites that will participate in the survey (add as many sites as necessary for your organization). If your clinic staff or the survey sample size is small, you may consider changing or removing question 2 ( What is the name of your primary workplace? ) and/or question 4 ( What is your primary role within this organization?') to ensure confidentiality and anonymity for all respondents. STEP 3: Selecting the Questionnaire Sites and Timeline You should decide which clinics will be surveyed and when. If there are only a few clinics, it is recommended that you survey all of them. You should choose an acceptable time period (usually 1-2 weeks) during which all questionnaires will be completed. STEP 4: Sampling You should decide how many providers you will be asking to complete the questionnaire. If your clinic has a relatively small staff, it is recommended that you distribute the questionnaire to all staff, particularly to all providers (doctors, nurses, health promoters, etc.). It is likely that some staff members will refuse to participate. Because this will lower the number of completed questionnaires you receive, it is especially important that you distribute the questionnaire to as many staff members as possible. STEP 5: Administering the Pre-test You should complete the questionnaire yourself, and give the questionnaire to one or two people who are NOT a part of your sample (after the pre-test, they must not participate in the actual implementation; their data would be biased by their prior experience with the questionnaire) to make sure the questionnaire is understandable and easy to complete, and that the wording is culturally relevant. Please record how long each pre-tester takes to complete the questionnaire so that you know approximately how long each participant can expect to spend on the questionnaire. Implementation Guide for the HIV/AIDS KAP Questionnaire 3
Implementation STEP 6: Orienting Staff Orient Staff about the Purpose of the Questionnaire The next step is to orient staff about the objectives of the questionnaire in order to secure their support, which will make completing the questionnaire much easier. Staff should be made aware that the questionnaire will allow your organization to develop capacity-building materials, trainings, and programs to improve health services related to HIV/AIDS/STIs and VCT. This should be done before the questionnaire is handed out, and can be done in a variety of ways, such as making an announcement at a staff meeting, sending an email to staff, or placing a letter in staff mailboxes. Confidentiality Staff should be reminded that confidentiality is absolutely necessary to get honest and complete answers from participants. It is important to assure participants that the purpose of this questionnaire is not to evaluate performance, and will not affect anyone s work or position in any way. To the contrary, the purpose is to gather accurate information on the perspectives of staff on the subject of HIV/AIDS. Information in all the questionnaires will be analyzed as a whole (not individually). Knowing that participation is confidential and anonymous will help staff feel comfortable answering the questions honestly. It is very important that all staff members, whether they are participating in the questionnaire or not, recognize the importance of confidentiality. No one on staff should read the responses of the participants, either while they are taking the questionnaire or after the questionnaire has been submitted. (Ideally, you should hire a person outside the organization to do data entry and analysis.) The following steps will help to guarantee confidentiality: First, provide participants with a semi-private space to complete the questionnaire, where no one is able to see their answers Second, make sure that the participant s name and identifying information is not written anywhere on the questionnaire. Finally, establish a secure location where participants will submit their questionnaire. This location could be a sealed box, or an envelope which the participant could seal before s/he submits their questionnaire. Once the questionnaire has been submitted, no one at organization should review the results. If you are unable to have external person do data entry, carefully consider who at the organization will be responsible for this, and ensure that only this person looks at the questionnaires. Implementation Guide for the HIV/AIDS KAP Questionnaire 4
STEP 7: Planning Logistics Once you have decided which clinics to survey and how many participants you hope to have, you must make logistical preparations: Create a timeline for distribution, implementation and collection of questionnaires. Especially for organizations with few sites, it is recommended that implementation take place in 1 to 2 weeks. Make enough copies of the questionnaire for the number of participants you plan to survey. Make sure there is a fairly private place for participants to fill out the questionnaire (they can complete the questionnaire at home if it is more convenient). Make sure there is a secure box or envelope where the completed questionnaire will be submitted. Preferably, the box/envelope should be located away from the front desk and other workspaces of staff members, as participants may not answer honestly or completely if they feel that others will read their completed questionnaire. STEP 8: Recruiting Participants The next step is to distribute the questionnaires. This can be done in several ways. If staff members are well informed about the questionnaire, the questionnaire can be placed in staff mailboxes or on people s desks. You can also give the questionnaire directly to staff, either individually or at a meeting. If you give the questionnaire directly to staff, first explain the purpose of the questionnaire to the potential participant. For example, you could approach the health provider and say, As you may know, our organization is participating in an initiative to improve our VCT and other HIV/AIDS-related services to at risk populations. We are conducting a survey of all staff regarding HIV/AIDS. The findings will be used to develop capacity-building materials, trainings, and programs to improve health services related to HIV/AIDS and VCT. If you decide to participate, all of your responses will be completely confidential and anonymous. You will not have to write your name anywhere, and analysis will be conducted by someone not employed at our organization. Completing this questionnaire should take less than 15 minutes. Would you be willing to fill out a questionnaire? If the health provider agrees to complete a questionnaire, proceed to Step 10 (Implementing the Questionnaire). However, in some cases, the health provider will hesitate or refuse. In this case, you could encourage the person by saying, Your responses would be extremely helpful to improve the HIV/AIDS and VCT services at this clinic. As I mentioned earlier, participation and responses are completely confidential and anonymous, and will not be used to evaluate your performance, and will not affect your job in any way. We are trying hard to get 100% of staff to participate. Are you sure you don t have time? Implementation Guide for the HIV/AIDS KAP Questionnaire 5
STEP 9: Tracking Participant Refusal It is very important to track the total number of staff members who are asked to participate, and the number who refuse. This way, an overall response rate can be calculated at the end of the process. (The response rate is calculated by dividing the number of completed questionnaires turned in by the number of staff overall who were asked to complete the questionnaire.) STEP 10: Implementing the Questionnaire If necessary, provide the participants with a somewhat private space for them to complete the questionnaire, where no one will be able to see their responses. Also, be sure to offer them a pen or pencil, in case they don t have one on hand. Be sure to tell the participants not to write their name or identifying information anywhere on the questionnaire. Participants can fill out and complete their questionnaire wherever they wish; however, if a participant has difficulty reading or understanding the questionnaire, an appropriate staff member can help this person read the questions and responses in a private location. It is important that the reader does not interpret or offer opinions about the questions, to minimize the chance that they influence the participant s responses. The reader should simply read the questionnaire out loud, word for word. To protect confidentiality, it is essential that the reader not share the participant s answers with anyone. Finally, instruct participants on where and how to securely submit their questionnaire. Whether it is to be placed into a sealed box or an envelope, they should be given clear instructions. Additionally, all staff members should be reminded that the questionnaires are confidential, and that once the questionnaire has been completed, no one at the organization will review individual results. Ideally, someone external to your organization should conduct the analysis, and present only grouped findings to the staff. Consider how and if you will follow-up with participants who have not submitted their completed questionnaire to you. Remember that confidentiality needs to be ensured throughout the follow-up process; you may have to remind ALL staff to complete the questionnaire if you do not have a record of who has completed it. Also, keep in mind that participation is voluntary; no one should participate against their will. Analysis STEP 11: Data Entry and Analysis Once all the questionnaires have been collected, data entry and analysis should be conducted. Ideally, an external consultant should be hired for data entry and analysis. (For assistance in choosing a consultant, feel free to contact IPPF/WHR). This toolkit includes an answer key and codebook to assist with data entry and analysis. Responses should be entered into a data base (available on the IPPF/WHR website in both SPSS and Excel). Analysis should group data so that responses are not attributable to any individual respondent. Implementation Guide for the HIV/AIDS KAP Questionnaire 6
STEP 12: Using the Survey Findings How your organization uses the information gathered through this questionnaire will depend on your reason for implementing it. Many organizations may use it to address gaps in knowledge among staff by providing training to address the issues illuminated by the questionnaire, or by creating a handout on Facts of HIV or reviewing basics of HIV at a staff meeting. In addition, the findings can be used to understand the attitudes of staff towards this area of work, and should inform the content of sensitization sessions for all staff. Implementation Guide for the HIV/AIDS KAP Questionnaire 7