Page 252 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 7 Original Research

Pilot test Western Cape Province and the appropriate Medical
Superintendents from the chosen subdistricts. This study
A pilot test was conducted in the Stellenbosch sub-district. adhered to the ethical principles of the Declaration of Helsinki
Participants in the sub-district were randomly selected to 2013. The researcher has the ethical responsibility to protect
complete the questionnaire. Eight participants completed the the human rights of the participants, such as their rights to
questionnaire. After completion of the questionnaire, a few privacy, confidentiality, autonomy, anonymity, fair treatment
changes were made to the questionnaire. The pilot test data and protection from discomfort and harm.
were not included in the main study.
Results
Validity and reliability
Biographical data
Reliability and content validity of the instrument were ensured
by making use of the literature, a review of the instrument by Most of the participants were recruited from healthcare
experts in the field of HIV and the pilot test. Content validity facilities (n = 20, 69%) in the Cape Winelands. The median
was determined by calculating a content validity index (CVI) for headcount in facilities was 2496.5 (interquartile range [IQR]
each item (called the I-CVI) in the questionnaire based on the 1460.5–5441.5), indicating a high patient load in the facilities
feedback of five experts. The I-CVI was calculated by determining with relatively high variability between facilities. The mean
the percentage of experts who rated the specific item as relevant. age of participants was 43.6 years, with a standard deviation
For an item to be considered relevant, four of the five experts (s.d.) of 9.98 years, the youngest being 25 years of age and the
had to rate the item as relevant (an I-CVI score of 0.8). For six oldest being 64 years of age.
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items in the questionnaire, one of the five experts rated the item
as not relevant (an I-CVI score of 0.8). However, this is still Table 1 presents the categorical biographical data of the
participants. Most of the respondents performed clinical work
acceptable according to the literature. For the remaining items, as a professional nurse. Participants in the ‘other’ category
all the experts rated the items as relevant (an I-CVI score of 1). were providing different services, for example, the prevention
They made suggestions to improve the clarity of items and these of mother-to-child transmission (PMTCT) manager from head
suggestions were incorporated in the final instrument.
office prescribed ART if there was understaffing in certain
clinics. Another participant was appointed as a psychiatric
The Cronbach’s alpha coefficient was used to establish the nurse but was also NIMART-trained and provided ART. One
reliability of the Likert scale items that measured confidence. participant indicated that she was a clinical mentor but was
The previously reported Cronbach’s alpha for the confidence also allocated to clinics to provide ART.
items was 0.94. In this study, the Cronbach’s alpha for the 22
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confidence items was 0.95.
Influencing factors
Data analysis The factors influencing confidence and knowledge included:
(1) HIV management experience, (2) training, (3) continuous
Data were entered into Microsoft Excel by the researcher, mentoring and support, (4) workload, motivation, facility
imported and analysed using the Statistical Package for Social equipment and general satisfaction, and (5) quality assurance
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Sciences (SPSS) software. HIV management confidence and mechanisms (see Table 2).
knowledge were measured as continuous variables by
calculating the total scores. The scores were converted to TABLE 1: Biographical data of the participants.
percentages to facilitate interpretation. A higher score indicated Variable Frequency (n) %
more confidence. Descriptive statistics were used to describe Gender
the data and appropriate statistical tests were used to test for Male 6 7.8
relationships between variables. As the confidence and Female 71 92.2
knowledge scores were normally distributed, the student t-test Highest professional qualification
was used to compare mean scores of two independent groups Postgraduate diploma in primary healthcare 44 57.1
or categories of influencing factors and analysis of variance Diploma 21 27.3
(ANOVA) for comparing more than two groups. The Spearman Degree 8 4 10.4
Other
5.2
rho correlation coefficient was used to test for associations Current function
between continuous variables, for example, scores and the Clinical work as a professional nurse 63 81.8
patient caseload of the participant (as the caseload was not Facility manager 8 10.4
normally distributed). A level of significance of < 0.05 was Other 5 6.5
used in this study. Clinical mentor 1 1.3
Type of facility
Ethical consideration PHC clinic 41 53.2
Community day centre 30 39.0
Ethics approval to conduct the study was obtained from the Community health centre 4 5.2
Health Research Ethics Committee at Stellenbosch University Mobile clinic 1 1.3
(S14/12/268). Permission was further obtained from the Other 1 1.3
Department of Health, City of Cape Town (City Health), PHC, primary healthcare

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