Community Health Research Round-Up, Issue 023

[mballard]

Hi all,

Happy new year! I know there has been some engagement w/theCommunity Health Research Round-up in the past on this forum so I wanted to share the latest issue and start a thread to share new issues as they’re released. Hopefully some of this sparks some dialogue and, at the very least, it’s nice to have everything in one easy-to-access thread.

The issue below covers papers indexed (largely!) since December 17. Please feel free to reply to the list with anything we may have missed.

• Should you have colleagues who’d like to receive these updates via email, please have them sign up here
• An abridged version of the round-up is also available on twitter—please follow the Coalition’s handle, @CHW_impact, and tag relevant colleagues!
• As always, previous editions of the round-up are available in our archive here

All the best,

Madeleine

Community Health Research Round-Up, Issue 023

Dec 17, 2019 - January 13, 2020

1. Development assistance for community health workers in 114 low- and middle-income countries, 2007–2017

• Comments: Helpful estimate of the level and trend of development assistance for CHW-related projects in LMICs over ~last decade by our very own CHIC member, Dan Palazuelos + company. Conclusion particularly of interest to colleagues at Financing Alliance, GFF ++

• Methods: Analysis of OECD’s creditor reporting system database

• Takeaway: The share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years.

2. The relative importance of material and non-material incentives for community health workers: Evidence from a discrete choice experiment in Western Kenya

• Comments: Important data on how to optimize crumbs.

• Methods: DCE (n = 199 CHWs in Kenya)

• Takeaway: CHWs’ most preferred job characteristic was high levels of community appreciation for their work which was valued approximately equivalently to receiving a 2000 Kenya Shillings (~US $20) monthly transport allowance. These incentives were valued more than appreciation from health facility staff or trainings six times per year. [N.B. Salary not one of the options]

3. Community health workers involvement in preventative care in primary healthcare: a systematic scoping review

• Comments: N.B. The aim of the review was to look for interventions serving disadvantaged culturally and linguistically diverse patients that may be applicable to the Australian context, so the review is limited to OECD countries
• Methods: Systematic scoping review
• Takeaway: A high-quality evidence-base supporting the positive impact of CHWs supporting patients’ access to healthcare and influencing positive behaviour change was found. Positive impacts of CHW interventions included improvements in clinical disease indicators, screening rates and behavioural change. Education-focused interventions were more effective in improving patient behaviour, whereas navigation interventions were most effective in improving access to services. Implementation was enhanced by cultural and linguistic congruence and specific training of CHWs in the intervention but reduced by short duration interventions, dropouts and poor adherence of patients

4. Unpacking the ‘black box’ of lay health worker processes in a US-based intervention

• Comments: Does the much needed work of beginning to identify mechanisms that underly the effectiveness of CHW interventions. Useful concepts for future implementation research.
• Methods: Direct observation using structured form
• Takeaway: CHWs utilized multiple relational strategies, including preparing an environment that enables relationship building, using recognized teaching methods to engage learners and co-learners as well as using humor and employing culturally specific strategies such as hierarchical forms of address to create trust.

5. Health Care Hotspotting — A Randomized, Controlled Trial

• Comments: The Camden Coalition, the subject of Gawande’s 2011 superuser article and a lot of other press, released a widely reported trial this week. The RCT–for which they should be commended for running, suggests that making hotspotting work depends on who you are trying to help (sicker elderly vs. younger poor) and what the program is offering…Colleague Shreya Kangovi has tackled the implications for all of us, penning some eloquent thoughts on regression to the mean and intervention design on her twitter page
• Methods: RCT
• Takeaway: In this trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition’s program than among those who received usual care.

[isaacholeman]

I wasn’t familiar with Shreya Kangovi’s work but I really appreciated her Twitter commentary on the Camden Coalition study. These CHIC research round ups continue to prove very helpful, thank you for sharing!