Development of a Sesotho health literacy test in a South African context

Background: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman­Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries

TB/HIV-Related Training; Knowledge and Attitudes of Community Health Workers in the Free State Province; South Africa

With its emphasis on task shifting and multi-trained and skilled outreach teams the primary healthcare (PHC) re-engineering strategy in South Africa depends on the training; knowledge and attitudes of community health workers (CHWs) to provide a variety of TB/HIV services. The aim of this exploratory research was to assess TB/ HIV-related training; knowledge and attitudes of CHWs. Interviews were conducted with 206 CHWs at 28 clinics in 1 urban and 2 rural sub-districts in the Free State province. Descriptive and bivariate analyses were performed using chi-square; Kruskal-Wallis (H) and Mann-Whitney (U) tests for non-parametric data. More than half (54.9) had not received basic training in HIV counselling and testing; almost one-third (31.1) had not received basic training in TB/directly observed treatment (DOT) support. Furthermore; most CHWs had not received any follow-up training in HIV counselling and testing and in TB/DOT support. Significant associations (0.01 p 0.05) between the types of CHWs and their sub-district location; and their TB/HIV-related training; knowledge and attitudes were observed. In respect of the TB/HIV knowledge items assessed; a large majority (95) were knowledgeable; with only a few being ignorant about important facts related to TB/HIV. Lay counsellors were significantly more knowledgeable about TB/HIV than TB/DOT supporters and other CHWs were. Most CHWs disagreed with stigmatising statements about people with TB/HIV. The sub-district location of CHWs was significantly associated with their attitudes towards people with TB/HIV. CHWs in the two rural sub-districts were more likely to agree with stigmatising statements. In the context of PHC re-engineering; this exploratory research suggests that CHW TB/HIV training; knowledge and attitudes can and need to be improved if integrated TB/HIV services are to be successfully task-shifted to them in line with policy recommendations.