Building Trust and Empathy Around COVID-19

"The training is very educational, I can now convince my family on the need to take the COVID-19 vaccine and I know it will be a positive response. I also learned how to cope with stress and fatigue and understood the concept of empathy." - Chief Nursing Officer, Federal Medical Centre, Jabi

Breakthrough ACTION-Nigeria implemented several data-driven social and behaviour change (SBC) interventions designed to support the Government of Nigeria in increasing COVID-19 vaccine uptake by addressing and overcoming vaccine hesitancy, including among health care workers (HCWs). These personnel are trusted messengers for SBC interventions but have reported they lack sufficient information on COVID-19 and COVID-19 vaccines; some remain hesitant to take the vaccine themselves. In response, Breakthrough ACTION-Nigeria developed a training curriculum that aims to not only build the skills of HCWs in providing empathetic care but also support them in navigating their own self-care to avoid burnout during an emergency.

The training combines an in-person component and virtual coaching support, along with reference materials that are available to anyone, such as the

• Implementation plan [PDF],
• Training participant's booklet [PDF],
• Vaccination awareness card game,
• A series of posters, along with a job aid wall chart, and
• 6 learning YouTube videos (see one example, below).

The modules outlined in the materials build upon global and local evidence on the COVID-19 response and complement the Nigeria National Interpersonal Communication and Counseling manual.

Breakthrough ACTION-Nigeria uses a collaborative learning approach to teaching and learning, which draws on a cluster of interrelated social and behavioural science theories that aim to describe how practices, norms, and behaviours become embedded in different social settings, including health services. Group problem solving one example of this approach, which is designed to increase knowledge retention about COVID-19 vaccination and testing information, strengthen bonds among HCWs, and reduce barriers to COVID-19 vaccine uptake among HCWs and priority populations.

Among the lessons learned are the following:

• HCWs should be approached as an audience, not just a communication channel. Many HCWs have themselves had negative personal experiences when they were clients interacting with the health system. Therefore, the training focuses on empathy, self-care, and the well-being of HCWs. It is meant to serve as a catalyst for conflict resolution among facility staff.
• Advocacy was necessary at the highest levels, including with leadership at the facility and public health associations, to get their buy-in with the step-down training approach. The step-down approach requires trained staff at the state level of the health system to serve as facilitators of the step-down trainings at the facility level. The project discussed this step-down training approach at the beginning of advocacy engagements as an expectation for participation in the training.
• High-volume secondary and tertiary facilities across all the selected states were extremely busy because of the COVID-19 pandemic, so groups of HCWs were organised in batches for the training.
• Training HCWs at the facilities in which they work has advantages and disadvantages. For example, it is possible to train as many HCWs as possible across different units/departments, which supports organisational normative change. However, HCW participants are often distracted and will need to come and go at times to respond to urgent matters.
• The step-down training approach necessitated considering and planning for incentives. For example, Breakthrough ACTION-Nigeria positioned the step-down facilitation role as a recognition of HCW champions and public service and something that could be highlighted on HCWs' resumes for future opportunities.
• The training approach and content were developed in a highly participatory and iterative manner. Breakthrough ACTION worked in close partnership with government agencies, service delivery partners, and potential beneficiaries from pilot facilities and members of the Network of People Living With HIV/AIDS in Nigeria. This ensured that the content met the needs of the intended audience while also ensuring ownership of the approach by the government so it could easily implement the training along with service delivery partners.
• Offering a variety of reinforcement materials is advisable and could be enhanced by future exploration that looks at questions such as: Are there online platforms that HCWs are more likely to use for peer-to-peer learning and coaching? Or could one leverage existing face-to-face meetings that HCWs already attend, like staff meetings and grand rounds, to facilitate this type of exchange and support? These are questions that Breakthrough ACTION is continuing to explore.