A stress management programme for HIV and AIDS home-based care practitioners in Tshwane

Abstract

The HIV and AIDS pandemic resulted in increased demands on the South African healthcare system and contributed to elevated stress levels among healthcare workers. Such experiences by healthcare workers, including home-based care practitioners, necessitated that employers in the HIV and AIDS field acknowledge that care-giving work is inherently stressful and feelings of distress were legitimate and not signs of personal weakness. An employee support intervention in the form of a stress management programme was implicated as being a potentially effective way of addressing workplace stress among HIV and AIDS home-based care practitioners. Therefore, it was the goal of the study to design, implement and evaluate a stress management programme for HIV and AIDS home-based care practitioners in Tshwane. Social constructionism was adopted as the theoretical framework and research paradigm of the study. The study was applied research, specifically intervention research (IR), sub-type Design and Development (DD). The research approach adopted was mixed methods research. The convergent parallel mixed methods research design was implemented in Phase One (problem analysis and project planning) and Phase Four (early development and pilot-testing) of the IR process. More specifically, the quantitative research design adopted in Phase One of IR was a non-experimental design, specifically the cross-sectional survey, while in Phase Four of IR the quasi-experimental comparison group pre-test - post-test design was utilised. The qualitative research design adopted was the instrumental case study in both Phase One and Phase Four of the IR. Two populations participated in the study. The first population consisted of all HIV and AIDS home-based care practitioners in Tshwane working for non-governmental and community-based organisations, estimated to be about 300 people. The second population was the supervisors/ managers of the home-based care practitioners estimated to be about 30. Non-probability sampling methods were used to recruit participants for the study. In Phase One of the IR, purposive sampling was used to recruit HIV and AIDS home-based care practitioners (n = 35), while, with the supervisors/managers (n = 5), key informant sampling was adopted at each organisation in four regions of Tshwane. In Phase Four of the IR, volunteer sampling was utilised to identify participants: twelve (n = 12) participants were exposed to the programme (i.e., experimental group) and seven (n = 7) comprised the comparison group (n = 7). The two groups were identified from two different organisations in Tshwane rendering home-based care. Quantitative data were collected in Phase One of the IR through a non-standardised self-administered questionnaire (measuring job satisfaction and dissatisfaction) and in Phase Four of the IR, the Oldenburg Burnout Inventory (measuring disengagement and exhaustion) was administered to the participants at pre-test and post-test levels. The qualitative data were collected through semi-structured interviews with interview schedules. In Phase One of the IR the interview schedules were used with both the home-based care practitioners and the supervisors/managers. In Phase Four of the IR, semi-structured interviews were conducted with the experimental group before and after exposure to the prototype intervention programme. Additional data were gathered through session evaluation forms. The qualitative findings revealed that the (prototype) stress management programme was effective in mitigating the impact of workplace stress experienced by the HIV and AIDS home-based care practitioners. The participants reported improved ability to cope with work stress after exposure to the intervention and this was expressed in post-test interviews and session evaluation forms. The quantitative results, on the other hand, indicated that the intervention programme had a minimal effect in mitigating the impact of the workplace stress. The pre-test results revealed that the experimental group was more disengaged and exhausted than the comparison group. At post-test level the experimental group and comparison group reported the same level of disengagement, whilst the experimental group indicated slightly higher levels of exhaustion than the comparison group. Post-test scores minus pre-test scores on disengagement and exhaustion revealed that the experimental group was less disengaged but more exhausted after exposure to the intervention. The comparison group was more disengaged and exhausted at post-test. Association between disengagement and exhaustion and the participants’ highest qualification level indicated that the group who had obtained Grade 12 and higher showed decreased disengagement from their work and slightly lowered exhaustion at post-test level as compared to the group who obtained Grade 8-11. Based on the findings, it is recommended that the newly developed stress management programme be subjected to refinements and improvements to further establish its effectiveness in mitigating the impact of workplace stress among home-based care practitioners in Tshwane. Through the implementation of the refined stress management programme, the necessary adaptations to the programme can be proffered for implementation in similar field settings.