n .. ,� 1nun,ng ,n 1he use of one or more of 1hc in1croc1hc 111\' nrc,·cn1io11 coun!.elling models oimcJ nl flC�MI ri$\.: reduclion is; n:commendeJ fo1 counsellor.1 ond super'\ isors. Coun�llors :ihouhJ L.Ol\\\ 1he comm11ni1y lltc)' sc.-rvc
nnd 1hc nvniloble rcfenul opponunilies. lncy nl� miglu bcnelir fmm formal lmining on:
(o) lrunsmission and prc\cnrion of 1 IIV Md olher sexuolly 1.n1rumi11cd and blood home diseases.
(b) Inc n.11urul history of HIV
(c) Rec-0gn1lion und 1rca1men1 of opportuni�lic 1nfcc1ion.
(d) Nc,v 1hmipcu1ic ngenlS u�cJ 10 trcnl HIV nnJ AIDS (c) Pn:ven1ion eoun�lling 11nd rcfeml scrvico.:.,; (l'C RS), (0 Prevention case mnn.igc:mc:nl nn,I
(R) Olhcr 111\ prevention and supf'Orl !\Cl'\ icC'I avnilnblc: 1n lh c: comn1unil) (c i,:
,crvi� rc:lnlcd to substOJ1ce nbu,c ns-1nc:n1, cullu.rul compctcncc, adolescent cunccm·, domestic nhu,;e nnd henlth concerns for gay or lesbi3.0 clic:nl'I) . .\dditionnl tmin1ng in specific coun•.clhng skills is alo;o \\"lllTarlled (c.g
1r.un1ny on hn,v to f.1ciliu11c: 1.1f11Ups for counsellors conducting group =�ions, (Tcchn1cnl f:.xpcrt P1111CI Review of CDC, '.>006)
i Supt!rvl,or oh�trvatlon and lmmc:dlalr fttdhat'k 10 coun•cllnr,
Oirc:ct obscrvotiCln of c:ounsclling 1eu1oiu Cill1 help ensure: lhut ohjee1lves ul't"
being met (Klunb, D1llon, 1-ishbein. Willis, on<l the Projeet RHSPECT StuU) Group 1 1 )96). Surcrvi�rs can pc:rrom1 this lO..\k perinJic;11ly (with cli en t consent).
S�si(lns ,.,n ulso be n11<l10 tupc:d (with client con:.cnl). or cnun�lling �n b.:
dcmonstnllcd through role piny sccnnrios bcl"ttn the counsellor.. 11.nd lhc supcl'\;SOl'!I. Ob• crvn1ion onJ fecd'1,.1cJ.. �hCluld be S1rue1urcd, and the ouiconic ,hould be c1,n,1nK;livc, no1 punitive:. Supcr\1sor.1 ,hould suppnn po,ili\e elements of the prcv.::ntlon counsclhns .os,on anJ provide spccilic. c:on.,tructh c conunen�
rego.n.hng conu:01� nreas needing improve1ncn1 Oh· ·1vn1ion nnd l�b.lcl( should be conduclcd rc:11ulurly for rou11ne co�lling St.irr ,li1eomf,,r1 "ith ohscn'lluon
so
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lypicully ,vnrt I ovcr1imc, muny coun .•Hom rcp:1rt thnr f.CniOM arc useful in cnh:\ncin11 ,kills. When obscrvolion i!> offered routinely, clients 11eldom re-fu:;e IO p.1r1iclpalc A su1111c�1ed lhnc rrnme for routine, direct observation of on I IIV prcvcnuon counsellor hy lhc \Uperviwr is twice m(lnlhly for the first six months.
monthly for the scc.ond six month.'I, and quancrly ror counsellors with more than one ycnr experience. After observnt1on. ,upcrvisor, should provide foorlb:M:k ID counsellors quickly preferably the some ,vecL:.
l rerlodlc evaluation 11f ph)slr11I ,pace, clltnt now, and time concl'tlls
Coun�cllin I sc �ion.,; should be conducto:J in .11 private spaoe "'hac dt::ars::u:m cnnnot be ovcrhcunl. ClicnL'I �hould nol wu,1 for long period bctv.cc:n lcSlmg and co11MC1ling and •nfomu111on could be provided during 1,1.uiting times (e.g. tl .... 'OC.lgb
videos). Periodic tia1�no,v llfllll y..cs or client survey can be •m:d 10 C"\-;tl�
ndcqUAcy ofsp4oc, client flow nnd length ofwuiting period.
•I, Periodic coun.sellor or client utbfactlon C\·aluacioo
I .vnlualion of clicnl .;11bfoc1ion C4ll =un:: llut counselling mcdS climl i,ccd rbr:!;c evaluntion o.lso CWJ provide fccdoo.cl: 10 counscllon "'ho othc:rnisc might not
sec 1heo benefits of ,,·tuit they do. Evalwtion Cllll he brief. Sun-q· should address ,vbcthcr specific counselling goals 1,1.,m: met., the type of i.nm-acuoo (c � -uh, i.1lktd more, 1hc ca111l>ellor or lhc cllent"), nnd, 1,1.fM:n llppl..-,,.Nc. sp«iiics of dcvclopmcnl of lhc n5k-m:luction rlan (c S· ..,_,lull "!IS the t-cm,,our c"1 � �-;,
that )'Ou a1::nxid to \\"Ori.: on?). Linking oouns.cllo� and clim::s des:. ipba:i cl • pG111culnr session mlllht hc: usefl1l. ConJuc1ing such cvafll31aoas onl) � (e.g. fnr 1-2 ,,o:cks on1·c tlr l\liiC:C a ycnr) � the � bc:nkn en:) u
r11oh:ihly aurlicic-11110 ttkntlfy rrol,lcrns tCOC, �0(16�
,. (.'as� coofrr,·n(n
ltcuulnrl) hC'JulC'J n1ccting ,,f u"lunscll,°"' all,"' IUI'-...� '° �
co111�1lom' u.1111 u0tl un,.,s ll\llt ncc.l IIOJ1l�l\'C1tletll an.I am heir �lk�� kart\
1«hnl11110 lrnn1 1hclr cnllC",11'.llt'S. \.14lu, c,,nft�� 9"' Ill\ .., � :If
,:ounM:llnra h11h1K11U _, 111, 11r pl'\,hlCll\.'lll, 11��\l\ Ml.C'J M ,l;a1t.;., 1 '"
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providers to better unilenw1l1d the oonccm, fi tnt; clients \\ho arc tllV-infcct.:d 01 11t inc�scd nd for IIIV Case confct'CllttS can heir ofis:et coun..<;t'.llnr 11111guc nnd
.. hum out" hy pn,viding a p.>si1h-c outlc:t for Jcahng ,,ith difficult silu:11um.-.
l>isc1elon m1ih1 fricu.• on lurd-to-ixtdrcss chrnl or spccilic rlnnm� (c g
®'tloplng occcpuihlc Dnd pncucal nsl:-rcduclK!n rlan� \\1th clients "ho deny tltl"' nugnltudc of HIV nsk) frequency of ca\C confermccs shouh.l he h.'llrultt)(I ,\lith the client \'Olunx, w,1h efforts made tn mcci ol least monthly (Cl>C, 20061,
( 01 rtplunl f n1mM1"0rk
I hcorics 1100 nlOdcls arc \'Cl')' important tools ,n health education, bcuically hccau!C tl ic)
provide the lmi, for \Jlltkrst:uhli ng 1001\idual bcluvlour onJ tho� foctors that 1nllucntt
such bcluvioUR m:ihhng JW•llJ� to he dcvcloi,cd to rro,idc 110lu1ions ond basin 101 rlnr,n,ng Dl'JllOpri ttc imcn't'ntion (llricga, 1999) l"hcory hll• hccn consid�n-J n, n sy:stcmatiClllly organl,cd l."TIO"lc:dge arrlicahlc in n rclati\icly wide ,'Briel.)' nl ctroJll\stnncc, dc:\,scd to MAl)7,C. rrc,.lict <W othcrni'IC c:.:rlaln the n.1111rc of l,ch.\\·iour ol'a
i;pccHied �, or bMic.i.lly- 00115hJerc.d ft!! o , i,u.,I coru1ruc1 of rroroscJ CMWII linkages nnions II t of C•'lfK'q'lt, bchevcd 10 be ttlatcd 10 a l'Clrticular ruhlic henhh rrohlcn, r,..tclcroy, U1bc!lu, Stcc.ker 11n1I Cl.mz ( 199&), cmf'hnslrJns the importAnCCI of models ,vi1hi11
the .:nn1cx1 of an ccolc,i;ic:al f!CrJpcctivc ,ta1.:J th:11 t'tc,havlours result f ro m 1hc in1cmc1ion '1,c1wccn the ind1viJual nnJ the cnvironmcnt.:11 dctcnnl1111n� such rts biologi ca l,
Jl$)Chological. socio<Ullural and structural sphen-s, \lthich f M iliiatc 11, This position thcn:forc, imrlics th.it ii is very lmponan1 10 considl:'I' beyond the individual, or 11mup or
people <>r c\'cn on ol)�il.llion bu1 much more the inOuentinl environment ond socinl fl,ro.:s lhol nrc in,·oh·cd in generating or focilluting the intlividU4l' 5 behaviour,
In thi� stud)·. the PRFCfDE framt\\'Ori.; l',.fodcl ,vould be ndoptctl lo cxplnin ru, apprai!l:II of l'IIV counselling and testing icr.iiccs providctl for Ptqpunt \lt'Omrn 01 the entcn:unl clinics of Jericho Nursing t-l<>mc, Ocnc:ral lfospilAI, Jeric:ho 11J1d ,\droyo r,..1 111 cm 11 y
Teat hlng llo�pilAI, lblkllln
TI,c PREC f.Ofi fn®cwurt. l',.fodcl \\'11.S d�clopc:d by U1\\TC1"1Ct Green ,mtl hi, colleagues fur plnnning health otlucnlion progl'DJT\J'llcs (Green, Kreuter Deed, and P111tridgc.
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I 'IK J> lhc PRI CHDI 11 1111 ncron)ln n1CMing Preda poi!nl]. Rc1nforc1ng. nnd l1.ru1hhnt1 anr: , in I duc.inur:ul l)u1gncms and livaluation. The l'RHClil)R is n lnic --moJrl" mc.1n1 lnr Jl'USmnllc c:IIoru to c.h:s ng c I lenhh hch:i, 1our mlhcr Ihm for thcl,f)' dc:vrlormcnt The l'lll C'l•l)I· model srcc1fics li\-c difrc:rc:nt "'J1Agno�s", soc:i I, cp1Janiological
hch;,vioural, c:ducntioml anJ aJmlnlstn1!1,-c rolicy. The cJucotiorul Ji11gnos1s rhAsc of
Hl'KI c.:i Ill• "' anph:l:;11a 1hrc:c f.ii:con1 \\h1ch an, of hch:t\ iouml pcr.;rccthcs:
prcdi1rpo51ng l::ictOB, cn.,bhng focton.. ontl rcinrute1ng IDClor.i
I he c:xpc:c1cJ hch3viour m the c:asc of this t1ud) is 1h:11 the hc:alth 1ncili11cs i;houlJ cnsu�
1h:it clTccthc and clliclmt I IIV counselling orn1 1es11ng scl'\·iccs nn: pm, idcJ li.,r the pn:� llllnt \\'Omen 111 their rc,pccu,'C antcrullll clin1c::s. I h e m3Nli;cn1cn1 tennis nnd the {))O
S1;11• govc:mmcnl nrc those opcc1cJ to ensure thl, hcha,iour so that the prei;n11n1 ,�'On1cn in 1hc 11a1c ,,,II rcttl\ c i;<>Od unJ liJlllf.ictor, I IIV counllClling Md testing scr,u:cs. I hi 5 v.1l1 lcm! to� 111 the ideal tllV c:uunKlling unJ 1esting services, n:Juclng mothcr,10-c:!111,1 tmnsn1iul11n (t.l re ,) or Ill\' onJ lhe 1111cnJan1 tmuhles.
l In 11rcdl,f10,ln11 Factor,
Th<.--tc IIICtun on: <.-nllc:J bch�\ 1ouml an1c«tlrn1s 1h.11 rrovlJc mo11\111ion for the hc:h11\'iour II include,., l.nowlc:Jgc, hc:Hc:r,. values, and pcrc:ci�eJ self -cnicncy rac:tor... I or the \)O\emmcnt Of O)o- S1a1c nod the 11WU1£cmcn1 lcams of Jericho Nun.,ng llon1c, Cicn.:ml llo5piusl, Jericho llJlJ AJcoyu Mntcmi1y T caching llosri141, lbodAn. to be ohle 10 rro, iJc c:n�-.:the anJ c:llicitnt I IIV coun<.elhng and 1cs1inu s,crvice.s to 1hc rrcw,un1
\\t>n1c:n nt the: 11n1c1111tal cliniC3, lhcrc mllll be edcquaJc 1.nowlcdgc obou1 IIIV ond AH)S cridcmie9 in the state IUlJ 1n pn11icul111 runong 1hc on1cn.,tn1 clinic 111tcndcc:s, knowl«lictc nh,.1111 the 1m('(lnl\ncc of 11nJ bcnclil'I or IIIV counselling nnd testing, l'u\·ourublc
�ov,·mmcntal pohc,c,o nnd ho,pitnl policies th4t rovour the cst:ihli,hmcnl or J IIV cou11:.clllng and tc.,lins «f'·iccs 1h31 will $:lllsfy the eonsumcn of the Krviccs. Thi:c \\lll
<1ho,v their ..,,:due"- unJ l>clicfs. ·\l�('I lhcn: n1uM he tmincd rcnoMel in b:i.\ic 51.:ills of conducllnl! I rrv counselling and testing scm.icc,.. Thc:sc pcr.10nncl shoul!I include, d oc tors, nurses a.nd mtd\\iVI:$, coun....cllors nnd labomtOI) scientists 10 mcn1ion hut,, few, Thl 5 ,,,11
ponl'II)' their pc:n:ci\'c:J ,elf-cfficnc)', When: lhcsc f11c1nro. cxh1, t� "ill be motivation for 1hc m.inui;cn1cnt of the hospi1nl focilily to 0wblim a.n HIV cuun,c:lling unJ 11 :stinl!
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.en-ices that will be satisfllctory to the consumers (pregnnnl Y-'Omcn) liL'.e the cusc o f -\Jtoyo t.lntcmity Tcnching I lospiwl •. Yemeni. lbadwl; unlike the other l\vo Jericho hos1,itnls
Tbt enabling Factors
1lle5e urc: ulM> hehllvioural nntcccdcnts that do not only motivate but enable the morivruion to lie n:ali1.cd. One (:{Ill be n1olivn1cd to do something but the ,vhcrc,,ith.11 may not be thc:r.: to do iL Exnnlplcs of ,uch v,..,hcrc:,vitbal" factors include resources such a,; money, timr. m111cnol'> ond skill required to do 1L ln�c cnobhng fuctors must be there before nn cO"c--:tive ltlV coun'>Clhng ond testing services ore: enjoyed by the pregn.int \\Omen in Lhesc
�uncycd hospilllls in lb.id.in. The ovoilobility of money (fund), ,vhich could come cnhcr fron1 the Oyo sllltc government or sponsor agencies like Prcsidcnt'J Emergency Plan for AIDS Relief (l'EPFAR) 111 Adcoyo. avuilability of equipment, test rc:igcnts mid nnt.irctrovirol (AR V) drugs (mntcrial l'C$0urccs), well trnincd personnel (in Iii V cowtse.lliog o.nd testing sen-icc pro«du�) lil;e counsellors, nunc:, nnd mid,,i,·es.. doctors nnd lobomtory scientists and nlso, facilities for caunselling. thereby providing sumdby slcill nc:.�lcd for the service. It cun be so.id t.h.,t these factor.; ,,ere rcl11th·ely available 111
Adcoyo l\1otemity Tc:uching I lo!';J)ital, unlike the t\\'O Jericho ho 5J1 i1Dls And thi5 oa:ow11 for the bclO\\' stnndnrd lc\'cl of I UV ;,tl"·icu there.
Tht rtlnrorclna fucton
The reinforcing fuctor.. ire ractons 5ubscq�nt to bc!hll\'iour that pro,-ide conhnuing �,llnl or inc:cnti, c::i for the htho,·iour and con1nhu1e to i� pcr!ll\lC'!K'e or � For example, lfnn IIIV cnurucllln11 nnd t�cing i;cr.1� i, set up ,,ith \\Cll 1nuncd r,:TSOIVICI, u,lcc111111c anJ functlonin� c-quirincnl, drugs and fund anJ yet the numhc:ni of nnmdccs 1 chc Mte-n:ual clinic is 11111 fc\\, such IICT\·icc i, not hkcly to he suniuncd bcco usc: chcrc 1,
nothing lO rcinforre the JIWllO"..: of Hs ot11hll,hmrn1. The �infon;i ng flle10lll COfl0C:ming the I IIV ..-rvtco in this 11111Jy Include i;--1 u11h1y of the KtVieo, This \\-UUld t,c � hy itiaro5e 1n ANC allenJ«s, raluctlon in l\lothcr-to-<:hltJ,tnuwulssion (Ml'CT) of 1-11\', hust,cinds coming to ,he ANC w11h lhclr wl\-c, c., uuhzc 1hc ,en aces. e'IOpr�n of
s:uisfocdoo t,y the romunicrs nf 1he I IIY coun.'1Cll1 ng anJ IC'!llilll) (IIC'l) ..av,cc, and
\lohcn the l�p11al 1n111U£c:mml Is rcttt�lng con,mcndatioo Iron, the swe �''ffilmcnt lllld
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in tun, the: mnnagcnu:nt curr11ncml1ng the pmvidcf11 of the IICI GCM� Po,i t�
co,11,sc:llin9 given tu pregnant ,von1cn during the confitlcntaal dis.closure or rttult 1
another n:1nrorcin11 fnctor, It will hulld conlidcnce in the pregn.1nt women thcmsclve'I, the
hcnhh ,vori.c:rs nnJ the •.crviccs. 1 l u� will encournge every $Ulkcholtkr, 11\e �ovcrrunc:n:t the 1T1anagcmcnt nnJ the providers and even the eonsumcn of the services
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4.F.nTIC"A TTOl't,\L DI Ar.Nosis jjJr:IIA VIOUR,\L l. EPll>t.\llOLOGICAL I. QUALITY ()f' LIFT,
...C,... OIAG:\OSIS DIAG!liOSJS IHAGNOSIS
Predi.3po,i:i::: f:icton
· Kno,, ledge about 1-0VIAJDS epidemic•. in panicular omong prq;nanr \\omen
• Kno\\lcd11c about the bcnefilS of IICT •t A�C - It reduc:� t-fTCT of HIV
-All'C3dy r.raincd personnel in the condu,;t of
l HCT SCl'\'iccs (pcn:civcd ,elf- effic:.ai:y). I c:>
I - ... r.nDbling Fac:ton
• A,-.ilabil,ty of fund for IICT scr, ices {money cithct' ITom go,cmment or spomor
agcn!S·A,.ilabihty of equipment. Htv lt!>l -n:agm1$'kits And ARV drag, (material JQOun:cs for use)
Personnel trained/skilled in the conducts of HCT "ho an: rc:tdy 10 disc:hargc
\&h$fnctOnl) (skills).
-Foc:ilitie, for counselling DDd ic:sting for HIV (ilill)
R�loforclng fncton
-Good urilil)' of HCT service,
-Pregnant women ancnding ANC in large numbers bcc:W$C ofs;itisfactory HCT scn·iccs
• Resultant reduction in MTCT of HIV
- Husband ancnding ANC with wives to b.1vc the HCT. Post·tcSt counselling.
-Appreci11tion b> the consumers ofHCT scn·ic�itprcssing their Sol1lsfaction of the services
- Gu,cm111cnl w,nmen,Luiun to bospiUll fucilitic5 ;md be:ilrh wo,io.c:rs
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In document
Notes on Diffy Qs: Differential Equations for Engineers
(Page 43-48)