Manualised health support interventions: Their efficacy in a South African primary healthcare setting

The study examined the implementation efficacy of a stress-reduction intervention for people living with HIV/AIDS by health care workers in the Eastern Cape Province, South Africa. Informants were 20 health care workers drawn from two health facilities. There were 17 females (85%) and 3 males (15%). Participants engaged in a focus group discussion on their experiences using a theory-based manualised stress-reduction support intervention in primary care settings. Thematic content analysis of the data yielded the following themes characterising costs to faithful implementation: departure from manualised instructions and ad hoc improvisation of theoretical concepts; disruptive power dynamics; lack of grounding in community values; and implementation resource limitations. Manualised intervention implementation efficacy by health workers needs customisation to local culture and health service support services.