Community Health Research Round-Up, Issue 024

Community Health Research Round-Up, Issue 024

January 14, 2020 - January 27, 2020

  1. ‘Do you trust those data?’—a mixed-methods study assessing the quality of data reported by community health workers in Kenya and Malawi
  • Comments: High-quality data are essential to monitor and evaluate the performance, quality, coverage and equity of community health programs. The findings are damning. The strong recommendation for supportive supervision is notable

  • Methods: Mixed methods - quantitative data verification ratios + qualitative interviews

  • Takeaway: Only 15% of data were reported consistently between CHWs and their supervisors in Kenya + Malawi. Barriers to data quality mirrored those previously reported elsewhere including unavailability of data collection and reporting tools; inadequate training and supervision; lack of quality control mechanisms; and inadequate register completion. Supportive supervision should be provided to community health workers to ensure they collect and report high-quality data.

  1. Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study
  • Comments: This study assessed the association of remuneration systems of paid-for-performance ASHAs and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India. More bad news for fans of pay-for-performance. (A reminder that the WHO’s CHW Guidelinesuggests not paying CHWs exclusively or predominantly according to performance-based incentives–see the rationale in RR018 under #4 here)

  • Methods: X-sectional

  • Takeaway: ASHAs’ home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs’ home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors.

  1. Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach
  • Comments: Interesting premise - “because of their shared backgrounds, CHWs’ care of patients/program participants is assumed to be acceptable, and often not evaluated empirically.” This article does that across studies conducted in the USA
  • Methods: Systematic review + 5-dimensional depth analysis (focus, context, meaning, range,
    and voices)
  • Takeaway: Depth analyses elucidated a spectrum of patient responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations.
  1. Efficacy of a Community Health Worker–Based Intervention in Improving Dietary Habits Among Community-Dwelling Older People: A Controlled, Crossover Trial in Japan
  • Comments: Interesting healthy ageing paper from Japan. The CHW-based intervention improved dietary habits among older people.
  • Methods: Controlled, crossover design
  • Takeaway: The dietary variety score in the immediate intervention group significantly increased in the initial 2-month period compared with the delayed intervention group (effect size 1.60 points; 95% CI 0.75, 2.45). The intervention had a similar effect in the delayed intervention group in the subsequent 2-month period and the effects persisted for at least 2 months after the intervention in the immediate intervention group.

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

  • Comments: Great use of routine data
  • Methods: Synthetic control
  • Takeaway: In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care. Except for the utilisation of postnatal care, control sites also exhibited increases between pre- and post-intervention, but increases were minimal in comparison to the CHW intervention sites
  1. The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa
  • Comments: Sent in by round-up subscriber, Helen Schneider! Interesting identification of critical actors and patterns of relationships in the supervision of ward-based outreach teams (WBOTs) in a rural South African district. (N.B. A WBOT consists of an average of six CHWs, led by a professional nurse called a team leader)
  • Methods: Cross-sectional, social network analysis
  • Takeaway: Supportive supervision of CHWs can be thought of as a system of horizontal and vertical relationships that go beyond just one supervisor–supervisee interaction. In this study, supervisory relationships within teams functioned better than those between teams and the rest of the PHC system.
  1. Evaluation of a training program on primary eye care for an Accredited Social Health Activist (ASHA) in an urban district
  • Comments: More potential interventions that can be carried out by CHWs.
  • Methods: Pre/post, 1 year follow-up
  • Takeaway: ASHAs can be trained as PEC workers provided they have adequate support. Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1year. Monthly average OPD of vision centres increased by 23.6% after ASHA training.
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