Evaluating the effects of reproductive health training on provider behavior (Supplement)

University Of Minnesota, Minneapolis MN

Investigators

Linked publications & trials

Abstract

Abstract In sub-Saharan Africa, an environment with the world’s highest rates of human immunodeficiency virus, STIs, and multiple sexual and reproductive health challenges, training of health students in sexual healthcare is almost non-existent. This study is sited in Tanzania (Tz), a socially conservative, highly religious country where 34% of the population are Muslim. There are 13 health universities in Tz: 5 secular, 6 Christian-affiliated and 2 Muslim-affiliated. In our Training for Health Professionals RCT (N=412 students), the medical, nursing and midwifery students who received our comprehensive sexual health curriculum had moderate-to-large increases in sexual health knowledge, improved attitudes, and improved clinical skills compared to controls. Reflecting national statistics, 92% of students rated themselves “moderately” to “extremely” religious. Effects did not differ by discipline or demographics, but in secondary analyses, two religious differences were noted. Students who were Muslim showed a smaller increase in confidence in their sexual health knowledge scores than Christian students (β=-21.01, SE=6.53, p=.001). And while students agreed or strongly agreed that the curriculum was respectful across several demographics (97%), and sexual values (85%), the lowest acceptability ratings were for “religion and religious background” (70.3%). These analyses were exploratory as our study was not powered to detect religious differences and only 14.3% participants were Muslims. In our renewal award, in Aim 2, we are developing a train-the-trainer curriculum then will pilot the training to faculty at two other health universities: University of Dodoma (UDOM) and Kilimanjaro Christian Medical College (KCMUC), both Christian majority student bodies. In Aim 3, we will conduct a Phase IV trial at both sites with 3-, 6-, and 12- month follow-up. This supplement is to bring in sexual health experts who are Muslim to advise our curriculum and to add a third site. After the State University of Zanzibar (SUZA) learned about our study, they expressed interest in being involved. SUZA is a secular health university with majority Muslim students. Adding SUZA as a site will increase the likelihood for our project to exert a sustained, powerful influence on science and health. Ethically, highly religious students are likely to be the students most in need of sexual health education. Adding a Muslim majority site will increase our power to study effects by religious affiliation and religiosity. Showing this curriculum was acceptable to Muslim students and increased their knowledge, attitudes, and clinical skills will inform generalizability and has high potential to decrease religious objections to the curriculum. This in turn will increase the likelihood of wide adoption of this curriculum in Muslim countries and across LMICs where Muslim-affiliated universities provide significant health student training.