Participatory behavioural change to reinforce infection prevention and control for Ebola virus disease in Sierra Leone

Purpose

This study used a participatory mixed methods approach to evaluate the processes that health workers take in adhering to standard precautions, after being trained and supplied with materials, in order to ensure the strict adherence that is necessary to prevent Ebola infection.

The aim was to develop strategies to improve adherence to standard precautions through the assessment of knowledge, risk perception, self-efficacy, and barriers and enablers for standard precautions in primary health facilities. It also enabled better understanding of the perspectives of health facility staff and health committees on the use of personal protective equipment.

Outcomes

The research has helped understanding of the levels of knowledge, risk perceptions, barriers, and enablers of adherence to standard precautions for health care workers who were provided with basic equipment and training on IPC for Ebola control in Kenema District, Sierra Leone. The publications produced as a result of the study also outline what strategies health facility staff can use to improve adherence to standard precautions

Healthcare workers’ (HCW) level of knowledge about Ebola and IPC evolved dramatically over the course of the Ebola epidemic. HCW felt at greater risk than the general population because of their work at health facilities where Ebola patients might present, although the eventual provision of IPC supplies and training greatly increased their confidence and sense of being protected.

One main finding was a widespread, acute feeling of stigmatisation and isolation among primary health care workers. They were stigmatised and ostracised at work and at home, by friends, family members, fellow health professionals, and the broader community. As a result, health care workers described experiencing a profound sense of loss, loneliness, anxiety, isolation, and sadness, along with the disruption of their lives at work, in communities and at home. The workers interviewed during the research expressed continued commitment to their work despite these challenges.

Key Findings

During recovery from this epidemic and in future ones, the research recommended responders and donors to:

• Recognise and address the mental health and psychosocial needs of frontline primary health care workers subjected to intense and protracted fear and stigmatisation by the communities in which they live and work.
• Devise community engagement strategies that address not only knowledge on disease transmission, but also mental health and psychosocial needs Explicitly promote non-discrimination and nonstigmatisation toward all health workers.
• Give health workers guidance on psychological first aid.
• Support Ministries of Health in the development and implementation of national plans to integrate mental health services into primary health.

Key Outputs

• 3 peer review articles published (See below ‘Publications’ section for details).
• Health policy and planning brief published.
• A workshop presentation in Freetown by two co-investigators in June 2015 to key stakeholders from the national Ebola Response Consortium (ERC), UNICEF, CDC and others.
• An oral presentation at the American Society for Tropical Medicine and Hygiene’s annual conference, October 2015.
• Abstract accepted at the Global Symposium on Health Systems Research in November 2016.
• Project was presented at the Sierra Leone Health and Biomedical Research Group (HBIOMED-SL)’s Research Symposium held in March 2016.