Date of Award

12-16-2024

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

Leprosy, a neglected chronic tropical disease caused by Mycobacterium leprae, poses significant health challenges due to its potential for irreversible disabilities and disfigurement. Adequate leprosy training for healthcare workers (HCWs) is crucial for early detection and prompt treatment, thereby preventing complications and reducing transmission risks. This study aimed to revise and evaluate the effectiveness of leprosy LaKAR* training on knowledge and skills of leprosy among HCWs in primary healthcare in Pahang, Malaysia. The study employed a sequential exploratory, mixed-method design consisting of two phases. Phase 1a was a qualitative study identifying gaps in current LaKAR training among HCWs at the state and district levels. Ten leprosy managers from the TB/leprosy units in Pahang participated in semi-structured in-depth interviews via Zoom with data analysed using NVivo 12 software. Phase 1b involved strengthening the LaKAR training based on Information-Motivation-Behavior-Skills (IMBS) framework, incorporating findings from the literature, Phase 1a and expert discussions. Phase 2 was a parallel, single-blind, two-arm, cluster randomized controlled trial design conducted in primary healthcare clinics in Pahang, Malaysia. A total of 150 HCWs were randomized assigned to one of the six clusters (district health offices) and subsequently divide them into intervention and control groups. The intervention groups received the improved leprosy LaKAR training intervention, while the control groups received leprosy brochures. Self-administered questionnaire and skills assessment checklist were used to collect data at pre- and post-intervention stages. Descriptive and bivariate analysis were conducted using IBM SPSS version 26. The effect size was also measured using Cohen’s guidelines. The qualitative study identified gaps in training experience, content, delivery, and design of training between the state and district levels and among different districts. Three main barriers emerged: limited resources, lack of stakeholder’ support and training challenges. Six recommendations were made from leprosy managers: increasing budget allocations, selecting appropriate training areas, improving existing training structures, fostering stakeholders’ cooperation and support, enhancing communication skills, and improving training efficiency. In quantitative findings, there were no significant differences (p>0.05) in socio-demographic characteristics, knowledge, and skills scores between control and intervention groups at baseline. However, after the trial, the intervention group demonstrated greater improvements in knowledge (intergroup mean difference of 2.77, 90.8%, p< 0.01) and skills (intergroup median difference of 17.47, 97.1%, p< 0.01) of leprosy compared to control group. Large effect sizes of increases in knowledge and skills of leprosy were observed. The enhanced leprosy LaKAR training intervention significantly improved the knowledge and skills of HCWs, demonstrating its efficacy as a vital tool in leprosy control. Wider implementation of this training could transform leprosy detection and management, ultimately moving the country closer to achieving the goal of zero leprosy cases. Recommendations for further improvement of implementation have been presented to the stakeholders, including policymakers in the Ministry of Health and the TB/Leprosy unit of the Pahang State Health Department.

Initial

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Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2024.

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