A mixed-methods feasibility study of Nyamekela4Care: An intervention to support improved quality of care among service providers in low-resource settings

Abstract

BackgroundIn South Africa, health and care service providers (SPs) face many interconnected challenges at work, including inadequate training and supervision and high levels of burnout. Nyamekela4Care (N4C) was developed as an integrated intervention for SP teams, to support their ability to provide high-quality care through providing a structure for operating regular team meetings that includes training, empathic skills development, administration, case sharing and self-care. We aimed to determine the feasibility, acceptability, and preliminary effectiveness of the N4C intervention as a support package for SPs in resource-constrained settings. MethodsThis study utilized a mixed-methods, repeated measures design. Purposive sampling was used to recruit 42 SPs from two healthcare service settings in South Africa where teams of primary care clinic staff work together with home-visiting community health workers from community-based organisations. Data were collected across three timepoints. Self-report data were collected directly from participants at all timepoints, alongside qualitative interviews, investigating participants’ wellbeing, work satisfaction, work-related knowledge, and acceptability of N4C. A repeated measures ANOVA was applied to the data to test the preliminary effectiveness of N4C. Qualitative interview data were analysed using a thematic analysis approach to identify pertinent themes in the data. ResultsThe N4C intervention was found to be acceptable, with low uptake of the intervention at one site limiting interpretation of its feasibility. Qualitative data demonstrated that the intervention resulted in improved collaboration between organisations; improved capacity to practice self-care in certain cases; and improved work-related knowledge. Quantitative data identified a significant increase in work-related knowledge, but no significant differences for any other outcomes. The success of implementation may have been impeded by contextual factors such as uncertainty regarding contractual agreements for staff, staff attrition, lack of commitment and skill of some of the operational leadership and the small number of N4C meetings held. ConclusionWhile participants noted improvements in work-related knowledge, self-care and intersectoral collaboration as benefits of the intervention, the implementation of N4C, particularly at one site, limited our ability to assess its feasibility and impact. Further areas for quality of care intervention research are discussed.