Community Health Toolkit

Community Health Research Round-Up, Issue 025

So our little round-up just released its 25th issue! The goods are below :slight_smile:

Community Health Research Round-Up, Issue 025
January 28, 2020 - February 10, 2020

  1. Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment
  • Comments: Cost data for the Individualized Management for Patient-Centered Targets (IMPaCT) RCT in the USA. Yet more data suggesting that investment in CHWs produces a positive ROI!

  • Methods: Annualized expenses, cost savings, & return on investment for an average team of community health workers

  • Takeaway: Every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.

  1. The cost of the training and supervision of community health workers to improve exclusive breastfeeding amongst mothers in a cluster randomised controlled trial in South Africa
  • Comments: More cost data. This time from an RCT in South Africa

  • Methods: retrospective cost analysis, from an implementer’s perspective, of CHWs providing care and support to pregnant women and women with babies aged < 1 year in South Africa.

  • Takeaway: The cost per additional mother practicing exclusive breastfeeding was calculated to be US$7647, 88, with the supervision component of the intervention constituting 64% of the trial costs. Whilst CHWs may be a low cost alternative to professional health workers, they require skilled supervision to operate effectively. CHW training and supervision was shown to effectively improve coverage of CHW visits, improve knowledge of mothers about child care practices, as well as leading to improved household breastfeeding practices.

  1. Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation
  • Comments: Discusses different strategies for integrating CHW models within Patient Protection and Affordable Care Act (PPACA) implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology efforts, and also discusses payment options for such integration.

  • Methods: Programmatic and policy analysis, describing several components of PPACA that offer natural leverage points for the integration of CHWs

  • Takeaway: Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs.

  1. A Novel Lay Health Worker Training to Help Women Engage in Postabortion Contraception and Well-Woman Care
  • Comments: New intervention alert - postabortion contraception care delivered by CHWs. (N.B. b/c only four CHWs have completed the training curriculum substantial pre- and posttraining assessments are not possible. Only participant responses are reported.)
  • Methods: Pilot - (i) Evaluation of LHWs’ knowledge and skills throughout the training period consists of self-assessment, simulation trainer-assessment of LHWs, and participant assessment, (ii) LHW simulation session video recordings are reviewed by two study team members to evaluate LWH counseling skills using a modified Motivational Interviewing Global Rubric, (iii) Intervention participants assessed satisfaction with LHW skills using 5-point Likert-type scales and open-ended questions
  • Takeaway: When piloted with 60 patients presenting for abortion who lacked a regular health care provider and desired to delay pregnancy for at least 6 months, participants found the lay health worker skills and the counseling session highly acceptable. Specifically, participants reported feeling comfortable speaking to lay health workers about contraception and reproductive health care.
  1. Factors associated with home visits by volunteer community health workers to implement a home-fortification intervention in Bangladesh: a multilevel analysis
  • Comments: If you pay people for their work, they are able to actually do it! (And some other helpful takeaways on home visitation.) Notably, no talk of simply requiring proactive home visits.
  • Methods: Cross-sectional survey, semi-structured interviews, and analysis of programme-related data from sub-districts included in the caregiver survey of BRAC’s home-fortification programme
  • Takeaway: Households characteristics matter - those with older children and located >300 m from the SS’s house were less likely to have been visited by the SS, whereas those with caregivers who had ≥5 years of schooling were more likely to have been visited by the SS. SS characteristics matter - households in the catchment area of older SS aged >50 years were less likely to have been visited by the SS. Program characteristics matter - those with SS who received incentives of >800 BDT were more likely to have been visited by the SS.
  1. Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes
  • Comments: More evidence that distance matters. (For more on SAM, see Can community health workers manage uncomplicated severe acute malnutrition? review included in RR 002)
  • Methods: Secondary data analysis of this trial consisting of the disaggregation of children by their treatment provider independent of the health area, with the aim to assess whether providing treatment close to households through CHWs allows children to be admitted into treatment earlier and in a relatively less severe condition, with a positive impact on the treatment outcomes compared to standard care at the health facility (HF)
  • Takeaway: The addition of SAM treatment in the curative tasks that the CHWs provided to the families resulted in earlier admission and more integrated care for children than those associated with health facilities. CHW treatment also achieved better discharge outcomes than standard community treatment. (The results showed fewer children with edema at admission in the CHW group than in the HF group, anthropometric measurements at admission were higher in the CHW group, more children in the CHW group were cured, and there were fewer defaulters than in the HF group. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases (diarrhea, malaria, ARI) than HFs)
  1. Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries
  • Comments: This study aimed to examine CHW and patients’ perceptions of a new mHealth intervention (Common Application Software [CAS]) for CHWs in India
  • Methods: Qual (thematically coded interviews). CHWs (n = 32) and patients (n = 55)
  • Takeaway: The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Patients’ views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation.