Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners
Abstract
Building trust and therapeutic relationships between healthcare providers and patients is crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals’ [HCPs] SRH history-taking practices and experiences. This paper describes HCPs’ interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practising health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations, application of evidence-based techniques, and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview
Downloads
References
Annon, J. S. (1976). The PLISSIT Model: A proposed conceptual scheme for the behavioural treatment of sexual problems. Journal of Sex Education and Therapy, 2(1), 1– 15. https://doi.org/10.1080/01614576.1976.11074483
Davey, S., Davey, A., & Singh, J. V. (2014). Mobile-Health approach: A critical look on its capacity to augment health system of developing countries. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 39(3), 178–182. https://doi.org/10.4103/0970-0218.137160
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Barry, M. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361–1367. https://doi.org/10.1007/s11606-012-2077-6
Elwyn, G., Laitner, S., Coulter, A., Walker, E., Watson, P., & Thomson, R. (2010). Implementing shared decision making in the NHS. BMJ, 341, c5146. https://doi.org/10.1136/bmj.c5146
Fawcett, T. N., & Rhynas, S. J. (2012). Commissioned CPD on history taking. Nursing Standard, 26(24), 41–46.
Frederick, N. N., Campbell, K., Kenney, L. B., Moss, K., Speckhart, A., & Bober, S. L. (2018). Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective. Pediatric Blood & Cancer, 65(8), e27087. https://doi.org/10.1002/pbc.27087
Frumence, G., Nyamhanga, T., Mwangu, M., & Hurtig, A.-K. (2013). Challenges to the implementation of health sector decentralization in Tanzania: Experiences from Kongwa district council. Global Health Action, 6. https://doi.org/10.3402/gha.v6i0.20983
Government of Tanzania. (2017, January). Tanzania Digital Health Investment Road Map 2017- 2023. https://www.path.org/resources/tanzania-digital-health-investment-road-map-2017-2023/
Hamad, W. B. (2019). Current Position and Challenges of E-health in Tanzania: A review of literature Master of Science in Information System. Global Scientific Journal, 7(9), 364-373.https://www.academia.edu/40378051/CURRENT_Position_and_Challenges_of_E_health_in_Tanzania_A_review_of_literature_Master_of_Science_in_Information_System
Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: The difference one word can make. Journal of General Internal Medicine, 22(10), 1429–1433. https://doi.org/10.1007/s11606-007-0279-0
Hordern, J. (2016). Religion and culture. Medicine, 44, 589–592.
Ingram, S. (2017). Taking a comprehensive health history: Learning through practice and reflection. British Journal of Nursing (Mark Allen Publishing), 26(18), 1033–1037. https://doi.org/10.12968/bjon.2017.26.18.1033
Joosten, E. a. G., DeFuentes-Merillas, L., Weert, G. H. de, Sensky, T., Staak, C. P. F. van der, & Jong, C. A. J. de. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health Status. Psychotherapy and Psychosomatics, 77(4), 219–226. https://doi.org/10.1159/000126073
Krueger, R. A. (2014). Focus groups: A practical guide for applied research. SAGE Publications.
Mahlich, J., Matsuoka, K., & Sruamsiri, R. (2017). Shared decision making and treatment satisfaction in japanese patients with inflammatory bowel disease. Digestive Diseases, 35(5), 454–462. https://doi.org/10.1159/000471795
McMahon, G. T., Marina, O., Kritek, P. A., & Katz, J. T. (2005). Effect of a physical examination teaching program on the behaviour of medical residents. Journal of General Internal Medicine, 20(8), 710–714. https://doi.org/10.1111/j.1525-1497.2005.0159.x
McQueen, F. M., Stewart, N., Crabbe, J., Robinson, E., Yeoman, S., Tan, P. L. J., & McLean, L. (1999). Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Annals of the Rheumatic Diseases, 58(3), 156–163. https://doi.org/10.1136/ard.58.3.156
Mgopa, L. R., Rosser, B. R. S., Ross, M. W., Lukumay, G. G., Mohammed, I., Massae, A. F., … Bonilla, Z. E. (2021). Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: A qualitative study of health professionals’ experiences and health students’ perspectives. BMC Public Health, 21(1), 676. https://doi.org/10.1186/s12889-021-10696-x
Mkonyi, E., Mwakawanga, D. L., Rosser, B. R. S., Bonilla, Z. E., Lukumay, G. G., Mohammed, I., … Wadley, J. (2021). The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania. Child Abuse & Neglect, 121, 105268. https://doi.org/10.1016/j.chiabu.2021.105268
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health, 17(3), Article 3. https://doi.org/10.3390/ijerph17030835
Moore, A., Higgins, A., & Sharek, D. (2013). Barriers and facilitators for oncology nurses discussing sexual issues with men diagnosed with testicular cancer. European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society, 17(4), 416– 422. https://doi.org/10.1016/j.ejon.2012.11.008
Mwakawanga, D. L., Mkonyi, E., Mushy, S. E., Trent, M., Bonilla, Z., Massae, A. F., … Rosser, B. R. S. (2021). Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania. Reproductive Health, 18(1), 245. https://doi.org/10.1186/s12978-021-01294-6
Nuhu, S., Mpambije, C. J., & Ngussa, K. (2020). Challenges in health service delivery under public-private partnership in Tanzania: Stakeholders’ views from Dar es Salaam region. BMC Health Services Research, 20(1), 765. https://doi.org/10.1186/s12913-020-05638-z
Ohm, F., Vogel, D., Sehner, S., Wijnen-Meijer, M., & Harendza, S. (2013). Details acquired from medical history and patients’ experience of empathy – two sides of the same coin. BMC Medical Education, 13(1), 1–7. https://doi.org/10.1186/1472-6920-13-67
Oyedokun, A., Adeloye, D., & Balogun, O. (2016). Clinical history-taking and physical examination in medical practice in Africa: Still relevant? Croatian Medical Journal, 57(6), 605–607. https://doi.org/10.3325/cmj.2016.57.605
Palaiodimos, L., Herman, H. S., Wood, E., Karamanis, D., Martinez-Rodriguez, C., Sanchez-Lopez, A., … Leider, J. (2020). Practices and Barriers in sexual history taking: A Cross-sectional study in a public adult primary care clinic. The Journal of Sexual Medicine, 17(8), 1509–1519. https://doi.org/10.1016/j.jsxm.2020.05.004
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y
Peterson, M. C., Holbrook, J. H., Von Hales, D., Smith, N. L., & Staker, L. V. (1992). Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. Western Journal of Medicine, 156(2), 163–165.
President Office. (2017). Government of Tanzania—Hospital Management Information System (GoT-HoMIS). Joint and Aligned Investment in Digital Health Information Systems. Regional Administration and Local Government. https://www.healthdatacollaborative.org/fileadmin/uploads/hdc/Documents/Country_documents/Tanzania_GOT-HOMIS_presentation_12Sept2017.pdf
Read, S., King, M., & Watson, J. (1997). Sexual dysfunction in primary medical care: Prevalence, characteristics and detection by the general practitioner. Journal of Public Health (United Kingdom), 19(4), 387–391. https://doi.org/10.1093/oxfordjournals.pubmed.a024665
Reno, H. E., Park, I., Workowski, K., Machefsky, A., & Bachmann, L. (2022). A guide to taking a sexual history. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centres for Disease Control and Prevention. https://www.cdc.gov/std/treatment/sexualhistory.htm
Ribeiro, S., Alarcão, V., Simões, R., Miranda, F. L., Carreira, M., & Galvão‐Teles, A. (2014). General practitioners’ procedures for sexual history taking and treating sexual dysfunction in primary care. The Journal of Sexual Medicine, 11(2), 386–393. https://doi.org/10.1111/jsm.12395
Richards, L. (1999). Using NVIVO in Qualitative Research. SAGE.
Ross, M. W., Newstrom, N., & Coleman, E. (2021). Teaching sexual history taking in health care using online technology: a plissit-plus zoom approach during the coronavirus disease 2019 Shutdown. Sexual Medicine, 9(1), 100290–100290. https://doi.org/10.1016/j.esxm.2020.100290
Saldana, J., & Omasta, M. (2018). Qualitative research: Analyzing life. SAGE Publications.
Sirili, N., Frumence, G., Kiwara, A., Mwangu, M., Goicolea, I., & Hurtig, A.-K. (2019). “Doctors ready to be posted are jobless on the street…” the deployment process and shortage of doctors in Tanzania. Human Resources for Health, 17(1), 11. https://doi.org/10.1186/s12960-019-0346-8
Skelton, J. R., & Matthews, P. M. (2001). Teaching sexual history taking to health care professionals in primary care. Medical Education, 35(6), 603–608. https://doi.org/10.1046/j.1365-2923.2001.00926.x
Van Dijk, N., Boer, K. R., Colman, N., Bakker, A., Stam, J., van Grieken, J. J. M., … Wieling, W. (2008). High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: The fainting assessment study. Journal of Cardiovascular Electrophysiology, 19(1), 48–55. https://doi.org/10.1111/j.1540-8167.2007.00984.x
Copyright (c) 2023 Ever Mkonyi, PhD, Maria Trent, Dorkasi L. Mwakawanga, Agnes Fredrick Massae, PhD, Michael W. Ross, PhD, Zobeida E. Bonilla, PhD, Inari S. Mohammed, Gift Gadiel Lukumay, Stella Emmanuel Mushy, PhD, Lucy Raphael Mgopa, PhD, James Wadley, PhD, Dickson Ally Mkoka, PhD, Brian Robert Simon Rosser, PhD
This work is licensed under a Creative Commons Attribution 4.0 International License.
