Community Health Research Round-Up, Issue 026 & 027

Research
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Issues 26 + 27. Item #3 from issue 027 on the design and implementation of a mobile health electronic data capture platform that functions in fully-disconnected settings is likely of interest to this group!

Madeleine

Community Health Research Round-Up, Issue 026

February 11, 2020 - February 24, 2020

  1. An Emerging Model for Community Health Worker–Based Chronic Care Management for Patients With High Health Care Costs in Rural Appalachia

  • Comments: Helpful look at the process by which insurance companies in the USA offered their resources in support of a CHW program that improves diabetes outcomes

  • Methods: Case study

  • Takeaway: The team implemented a 2-pronged strategy of seeking grant funding and concomitantly engaging health insurance payers to validate the model and establish a payment model. Engaging the payers from the beginning of the project was a critical step.Two milestones: (1) Medicaid-managed care organizations agreed to quarterly meetings for the purpose of monitoring the project (2) Grant funding enabled the team to replicate the model at a scale that would enroll a population large enough produce generalizable results.

  1. An educational intervention in rural Uganda: Risk-targeted home talks by village health workers

  • Comments: Given the ongoing interest in precision public health, this is a nifty study looking at targeting health talks to people with health census-identified risk factors (malnutrition, diarrhea, respiratory disease, HIV, and poverty due to family size)

  • Methods: Each participant received a pre-test, immediate post-test and delayed post-test on their assigned HT topic and a pre-test and delayed post-test on a randomly assigned control topic. Differences in scoring were examined against controls and over time using paired t-tests and general linear regression analysis, respectively.

  • Takeaway: Home talks increase health knowledge of rural African mothers. Learners retain knowledge over time. Lack of literacy does not impede learning core messages.

  1. Development and Evaluation of a Mental Health Training Program for Community Health Workers in Indonesia
  1. Rural-Urban Differences in Roles and Support for Community Health Workers in the Midwest
  • Comments: More reflections on the urban/rural divide. Compare w/this review on expanding the use of community health workers in urban settings in RR issue 020.
  • Methods: Secondary analysis of the Community Health Worker Employer Survey in Nebraska
  • Takeaway: There may not be enough support or definition in the roles of CHWs in the Patient Protection and Affordable Care Act to provide a stable workforce structure to employ CHWs in community settings. Currently, Nebraska has adopted a set of core competencies and provides training resources and policy recommendations for CHWs. There is still considerable flexibility in allowing employers or organizations to train CHWs as they see fit since there are a variety of needs CHWs can help fill, which differ across urban and rural settings.

Community Health Research Round-Up, Issue 027

February 24, 2020 - March 9, 2020

  1. Theory-based Development of an Implementation Intervention Utilizing Community Health Workers to Increase Palliative Care Use

  • Comments: Interesting approach to intervention development. Would be great to see the efficacy tested

  • Methods: Description of intervention development

  • Takeaway: The Behavior Change Wheel (BCW) and Theoretical Domains Framework (TDF) were used to systematically investigate the barriers to use of palliative care services, identify patient and physician target behaviors for change, and design a pragmatic CHW-led intervention based on the barriers and target behaviors

  1. Clinic-Based Community Health Worker Integration: Community Health Workers’, Employers’, and Patients’ Perceptions of Readiness

  • Comments: Readiness to adopt any change and expect success requires a clear set of activities and support as a precursor to change. This is an interesting look at the (oft-overlooked) psychological readiness of those involved in integrating CHWs into clinic-based teams (cCHWs).

  • Methods: Mixed-methods cross-sectional (73 CHWs, 58 employers, & 106 patients)

  • Takeaway: CHWs felt significantly stronger readiness (i.e. appropriateness, management support, & change efficacy) to serve as clinically-integrated CHWs than did employers to hire them. Employers felt stronger readiness to hire than patients to utilize cCHW services.

  1. Design and implementation of a mobile health electronic data capture platform that functions in fully-disconnected settings: a pilot study in rural Liberia

  • Comments: A cool article by our friends at LMH for an increasingly rare, but absolutely critical use case. Context: “Many existing electronic data capture (EDC) mobile software tools are built for occasionally-disconnected settings, allowing a user to collect data while out of range of a cell tower and transmit data to a central server when he/she regains a network connection. However, few tools exist that can be used indefinitely in fully-disconnected settings, where a user will never have access to the internet or a cell network.”

  • Methods: Case study describing the design, pilot-testing, and scale-up of an open-source fork of Open Data Kit Collect that allows for offline Bluetooth-based bidirectional data transfer, enabling a system in which permanently-offline users can collect data and receive application updates.

  • Takeaway: Running a fully-offline EDC program that completely bypasses the cellular network was found to be feasible; the system is still running, over 4 years after the initial pilot program.

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Thanks for sharing @mballard!

The paper about Last Mile Health’s use of an ODK fork for peer-to-peer data sync in fully offline settings is indeed very interesting. Many on this form have used different versions of ODK a bunch, and we’ve wanted to work on an offline sync feature like that for the CHT for some time. We just recently received some funding to work on this in the coming year and I imagine @marc and @gareth will be interested in the technical details of Avi’s approach . Here’s another insight from the paper that I’ve discussed offline with Avi:

We also found that many CHWs would conduct client visits without their mobile device. They would then retroactively complete the forms during the evening, either from written notes or from memory. We initially identified this through field observations, and subsequently through an analysis of the timestamps automatically taken at the start and end of each form, noticing that batches of forms would often be filled out at the end of the day by a CHW. Within the time period analyzed, the median time between forms (excluding the time between the last form of a given day to the first form of the next day) was 10 min, which implies that the majority of CHWs were simply using the phones for retroactive “data entry” rather than using them as decision-support tools during the actual patient interaction. This finding led to field-based retraining of CHWs to encourage use of the phones as intended.

I know @erika and others are thinking about as we work on new tools for flagging data quality issues and prompting supervisors to address them.