Exploring the limited impact of patient-centred counselling and standardised health messages aimed at improving STI partner notification

Abstract

The present study set out to explore the limited impact of a randomised controlled trial comparing standardised health messages and patient-centred counselling for improving partner notification by patients with sexually transmitted infections (STIs) at Alexandra Health Centre and University Clinic in South Africa. Using contextual information collected throughout the course of the trial, it was possible to assess whether the proportion of patients asking questions after receiving the standardised health message, and/or the duration of counselling sessions, were associated with the number of patients whose partners subsequently sought treatment at the Health Centrefs pharmacy. By analysing transcribed audio-recordings of standardised health messages and counselling sessions it was also possible to compare what was said during each intervention and to assess the quality of information, advice and problem-solving discussions contained therein. While female STI patients were more likely to ask questions after receiving the standardised health message and were more likely to have longer counselling sessions than male patients, there was little evidence that either events were associated with more than a marginally (p.0.1) significant increase in the number of patients whose partners subsequently sought treatment at the Health Centre. However, partners successfully notified by patients who had received longer counselling sessions were more likely to present for treatment more than a day later, which could indicate that longer counselling sessions encouraged STI patients to contact partners who took time to trace. While patient language appeared to influence the amount of time spent counselling each patient, qualitative analyses of transcribed audio-recordings suggested that the less structured format of counselling sessions undermined the delivery of comprehensive information and advice, even though the counsellors involved often went to some lengths to tailor what was said to suit what they perceived to be each patientfs needs. Indeed, very few of the transcribed counselling sessions contained interactive problem-solving between counsellors and patients, and many counsellors failed to create a non-judgemental atmosphere in which to facilitate problem-solving by STI patients. Since most of the transcribed standardised health messages successfully delivered comprehensive information in a non-judgemental fashion, albeit with little interaction between nurse educator and patient, it may not be surprising that this intervention had a similar impact on partner notification as lay-counselling. Indeed, these findings may explain why a combination of both interventions was required to elicit a significant increase in successful partner notification in the randomised controlled trial. They suggest that counselling may need to include standardised health messages, delivered in a non-judgemental atmosphere, if it is to improve partner notification for STIs; and/or the delivery of healthcare messages in different formats by different health care practitioners may be necessary to elicit a significant change in subsequent health behaviour.