Inge Petersen1, Lara Fairall2, Catherine O Egbe3, Arvin Bhana4. 1. Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa. Electronic address: peterseni@ukzn.ac.za. 2. Knowledge Translation Unit, University of Cape Town Lung Institute, South Africa. 3. Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa. 4. Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa; Human and Social Development, Human Sciences Research Council, South Africa.
Abstract
OBJECTIVE: To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. METHOD: A qualitative systematic review of the literature on lay counsellor services in South Africa. RESULTS: Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. CONCLUSION: Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. PRACTICE IMPLICATIONS: Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling.
OBJECTIVE: To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. METHOD: A qualitative systematic review of the literature on lay counsellor services in South Africa. RESULTS: Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. CONCLUSION: Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. PRACTICE IMPLICATIONS: Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling.
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