Lay counselors' ability to deliver counseling for behavior change

Abstract

Options for Health is an evidence-based sexual risk reduction intervention based on Motivational Interviewing (MI). Thirty-nine antiretroviral adherence lay counselors were trained to deliver Options to help their patients to optimize their antiretroviral treatment adherence. An evaluation of counselors' ability to deliver the intervention after 35 hours of training revealed that counselors struggled with elements of the 8-step Options protocol and failed to achieve proficiency in MI. The current study aimed to determine the impact of refresher training and supervision on counselors' proficiency in the intervention. Method: Audio-recordings of counseling sessions were collected for 22 of 39 counselors after 18 hours of refresher training and supervision had been delivered over a 12 month period. Recordings were transcribed, translated and analyzed for fidelity to the Options protocol and the MI approach. Analysis was conducted using the Motivational Interviewing Treatment Integrity Tool and an instrument developed by the researchers. Results were compared to findings from an evaluation of counselors' performance immediately following the initial 35 hour training. Counselors improved their delivery of some intervention steps, but not others; their use of micro-counseling skills and therapeutic approach improved to such an extent that they closely approximated the MI approach. Conclusions: This study contributes evidence for the positive impact of on-going training and supervision on LHW practice. Although counselors did not achieve complete proficiency in the Options protocol, refresher training and supervision improved counselors' basic counseling communication skills and therapeutic approach, enabling them to deliver better quality counseling for behavior change.