Acceptability and determinants of integrated management of childhood illness strategy among nurses in Botswana, 2019

Abstract

Background – Children continue to be at high risk of dying before reaching their 5th birthday due to preventable and treatable conditions. A well-coordinated implementation of the IMCI strategy has been proven effective against these conditions. However, limited use of and poor adherence to IMCI guidelines has been consistently reported among healthcare workers, even with IMCI training. This study assessed acceptability and determinants of acceptability of the IMCI strategy, among primary healthcare nurses in Botswana.Method – A cross-sectional survey was conducted in the clinics, and health posts within four purposively selected health districts: Francistown, North-East, Tutume and Bobirwa in Botswana. The sample size was proportionally allocated by the type of health facility (clinic or health post) in each health district. Participants were randomly selected based on the type of health facility in each health district. Data were collected from 238 nurses using adapted psychometric tools to measure four indicators of acceptability and determinants (organisational support, and social relations) on a five-point Likert scale. Acceptability was presented as a composite score of affective attitude, self-efficacy, perceived effectiveness and experienced burden subscales. A cut-off point score for acceptability was determined using the 25th percentile. Data were summarised using median, interquartile ranges (IQR) for continuous variables, and frequencies and proportions for categorical variable. Binomial logistic regression models were fitted to identify determinants of acceptability. P<0.05 was considered significant.Results – Participants were mostly female nurses (62%), 81.9% diploma holders, 64.2% were IMCI trained, and 72% were working in rural-based facilities. The median scores and IQR for the determinants were 3.80 (IQR: 3.20, 4.20) for the social relations and support, and 3.00 (IQR: 2.55, 3.45) for organisational support. The median scores and IQR for the indicators of acceptability were 3.77 (IQR: 3.46, 4.15) for affective attitude; 4.00 (IQR: 3.80, 4.30) for experienced burden; 4.00 (IQR: 3.75, 4.25) for self-efficacy; and 4.00 (IQR: 3.72, 4.38) for perceived effectiveness. The median, IQR for acceptability was 3.97 (IQR: 3.75, 4.14). The strategy was acceptable to 74.7% of the participants. Identified determinants of acceptability were working in rural-based facilities [adjusted odds ratio (AOR): 0.25 (95% CI:0.08 – 0.80)], organisational support score [AOR: 2.89 (95% CI:1.34 – 6.25)], and social relations and support score, [AOR: 3.21 (95% CI:1.67 – 6.16)].Conclusion- Acceptability of the IMCI strategy was high. Organisational support and social relations and support enhance the acceptability of the strategy. Further research is needed to explain the risk of low acceptability associated with working at a rural-based facility.