SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 6 (March 20, 1998)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

The Mountain-Plains Regional AIDS Education Training Center/University of Colorado Health Sciences Center’s Improving HIV Services in Rural Areas project develops and evaluates the relative effectiveness of several instructional methods to improve HIV service delivery in rural areas. The three methods include a self-instruction study module, two-way interactive audiovisual teleconference training, and face-to-face presentations by rural outreach teams. The project conducted a study to assess the efficacy of these educational methods.

Providers from eight low HIV prevalence Mountain-Plains states — Colorado (CO), Kansas (KS), Nebraska (NE), New Mexico (NM), North Dakota (ND), South Dakota (SD), Utah (UT), and Wyoming (WY) — were enrolled. All states implemented the self-study method and four states (CO, KS, NM, UT) implemented the rural outreach team training method, while the other four states (ND, NE, SD, WY) implemented the audiovisual teleconference. The study design called for an intervention group of target providers who participated in the educational programs and a randomly selected comparison group of providers (controls) who did not participate in the programs.

Between January 1996 and September 1997, 45 training sessions were provided to 1,769 rural physicians, nurse practitioners, physician assistants, and nurses. Complete pre- and post-training evaluation information is available for 1,614 practitioners. Study results showed significant improvements in pre- and post-test HIV/AIDS knowledge scores, and self-ratings in skills/ability to provide services and willingness/comfort level scales for each of the three methods (p < .001). Outcomes related to impact on service delivery were significantly greater for the intervention group than the control group (p < .001).

Five-month follow-up data were collected for 591 providers on the trainings’ impact on service delivery and on current levels of activity compared to levels before training participation. At follow-up, trainees and comparison providers were asked to estimate whether they were providing "more," "the same," or "less" of various HIV-related prevention, early treatment, and health promotion activities than they were five months ago. Trainees reported significantly more activity than comparison providers did in nine areas (chi square analysis, p < .001). The chart on the right illustrates five of the nine areas (risk assessment, risk reduction counseling, HIV counseling and testing, prophylaxis, and antiretroviral treatment) that received the highest percentages of increased service activity as reported by providers at the five-month follow-up.

All three educational methods were successful in improving knowledge, skills and abilities, and willingness to provide HIV/AIDS services among rural health care providers, with the self-instruction study module resulting in the greatest increases. Eighty percent of respondents indicated that the trainings improved their ability to provide services. The project demonstrated that effective education and training can prepare rural providers to assume an active and essential role in HIV/AIDS prevention, early intervention, and health promotion activities.

For more information, contact Donna Anderson, Ph.D., M.P.H., University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Box A-089, Denver, CO 80262, 303.315.2516 (phone), donna.anderson@uchsc.edu (e-mail).

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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