Strengthening infectious disease prevention to support equity in selected District Health Directorates in Istanbul: a quasi-experimental training intervention for non-physician healthcare workers
1
Sultangazi District Health Directorate, Republic of Türkiye Ministry of Health, İstanbul, Turkey
2
Public Health, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
District Health Directorates are front-line public health settings where non-physician staff play a key role in outbreak prevention and equitable access to preventive services. We aimed to evaluate the effectiveness of a structured training programme for non-physician healthcare workers on infectious disease–related knowledge and perceptions, and on selected vaccination behaviours.
METHODS:
Quasi-experimental pre–post study with 3-month follow-up (Aug 2024–Mar 2025) in 10 District Health Directorates in Istanbul. Among 250 attendees, 206 completed all assessments. We measured knowledge with a 32-item questionnaire developed based on national guidelines and reviewed by subject-matter experts (each correct answer scored as 1; total 0–32). Perceptions were assessed with the validated Infectious Diseases Perception Scale (total score). Changes across time points were analysed using the Friedman test, and paired binary outcomes (self-reported vaccination status) were compared using McNemar’s test.
RESULTS:
Participants were 77.7% female; mean age 38.9±8.5; and 53.9% had not previously received infectious disease training. Mean knowledge scores increased from 18.0±5.6 (pre) to 25.4±3.0 (immediate post), and remained higher at 3 months (21.4±4.4; p<0.001). Perception Scale total scores rose from 159.4±13.0 to 165.7±8.8 and were 162.4±12.1 at 3 months (p<0.001). An increase in self-reported vaccination uptake was observed MMR vaccination rose from 60.7% to 70.4% and HPV non-vaccination decreased from 94.7% to 89.8% (McNemar p<0.001), although non-vaccination remained high. Despite partial attenuation by 3 months, gains remained above baseline, supporting the need for periodic reinforcement.
CONCLUSIONS:
To support equity, inclusion, and sustainability in district-level public health services, brief and scalable training programmes may improve infection prevention knowledge, perceptions, and selected vaccination behaviours; embedding periodic booster sessions and tailored reinforcement within routine in-service training may help sustain gains over time, particularly among staff without prior infectious disease training.
District Health Directorates are front-line public health settings where non-physician staff play a key role in outbreak prevention and equitable access to preventive services. We aimed to evaluate the effectiveness of a structured training programme for non-physician healthcare workers on infectious disease–related knowledge and perceptions, and on selected vaccination behaviours.
METHODS:
Quasi-experimental pre–post study with 3-month follow-up (Aug 2024–Mar 2025) in 10 District Health Directorates in Istanbul. Among 250 attendees, 206 completed all assessments. We measured knowledge with a 32-item questionnaire developed based on national guidelines and reviewed by subject-matter experts (each correct answer scored as 1; total 0–32). Perceptions were assessed with the validated Infectious Diseases Perception Scale (total score). Changes across time points were analysed using the Friedman test, and paired binary outcomes (self-reported vaccination status) were compared using McNemar’s test.
RESULTS:
Participants were 77.7% female; mean age 38.9±8.5; and 53.9% had not previously received infectious disease training. Mean knowledge scores increased from 18.0±5.6 (pre) to 25.4±3.0 (immediate post), and remained higher at 3 months (21.4±4.4; p<0.001). Perception Scale total scores rose from 159.4±13.0 to 165.7±8.8 and were 162.4±12.1 at 3 months (p<0.001). An increase in self-reported vaccination uptake was observed MMR vaccination rose from 60.7% to 70.4% and HPV non-vaccination decreased from 94.7% to 89.8% (McNemar p<0.001), although non-vaccination remained high. Despite partial attenuation by 3 months, gains remained above baseline, supporting the need for periodic reinforcement.
CONCLUSIONS:
To support equity, inclusion, and sustainability in district-level public health services, brief and scalable training programmes may improve infection prevention knowledge, perceptions, and selected vaccination behaviours; embedding periodic booster sessions and tailored reinforcement within routine in-service training may help sustain gains over time, particularly among staff without prior infectious disease training.
| eISSN: | 2654-1459 |
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