Community health worker empowerment through collaborative models with community midwifery

Dewi, Arlina; Supriyatiningsih, Supriyatiningsih; Sundari, Sri; Sugiyo, Dianita; Dewi, Dyah Tri Kusuma

doi:10.11591/ijphs.v12i2.22431

IJPHS

2023

DOI: 10.11591/ijphs.v12i2.22431

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Community health worker empowerment through collaborative models with community midwifery

Arlina Dewi

Supriyatiningsih Supriyatiningsih²,

Sri Sundari³

et al.

Abstract: From 2007 to 2015, Indonesia’s maternal mortality rate (MMR) increased from 228/100,000 to 305/100,000 live births. The government has established a policy to reduce the MMR in rural and remote areas, which includes the maternal waiting home (MWH) program and the placement of community midwifery. However, the use of MWH in Indonesia, such as in South Sulawesi Province, remains low. This study aimed todetermine the impact of the community health worker (CHW) Empowerment Collaboration Model on the use of materna… Show more

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2024

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Cited by 2 publications

References 27 publications

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Effectiveness Of a Community Health Worker-Led Education Intervention on Knowledge, Attitude, and Antenatal Care Attendance of Pregnant Women in Eastern Uganda. A Quasi- Experimental Study

Lee,

Kasibante,

Eminai

et al. 2024

Preprint

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Background Uganda experiences high maternal mortality ratios, with suboptimal utilization of maternal health services like antenatal care (ANC), especially in rural areas. Community Health Workers (CHWs), known as Village Health Teams (VHTs), have shown the potential to enhance maternal and child health (MCH) outcomes in Uganda by educating pregnant women in the community. However, their training models need to be refined to boost their performance.Objective We evaluated the effectiveness of a contextually tailored educational intervention delivered by VHTs on the knowledge, attitudes, and antenatal care attendance of pregnant women in Eastern Uganda.Methods We performed a quasi-experimental study using a pre-post-intervention evaluation conducted over six months in Eastern Uganda. We included pregnant women in their first trimester who consented to participate and excluded those in later trimesters. We performed multistage sampling with villages randomly selected and participants enrolled by trained VHTs. The VHTs were trained using a Maternal Newborn Child Health curriculum developed by a multidisciplinary team of healthcare professionals. The VHTs delivered educational sessions to the participants during home visits throughout their pregnancy. Data was collected on pregnant women's knowledge, attitudes, and antenatal care attendance before and after the intervention. A score of ≥ 75% was considered sufficient knowledge. The Chi-square test was used to test the difference in the proportional change in knowledge and attitude of pregnant women. A paired two-sample t-test assessed changes in ANC attendance pre- and post-intervention. A p < 0.05 was considered statistically significant.Results 228 participants were included, with a mean age of 27 ± 5.90 years and gravidity of 2.92 ± 1.47. There was a significant improvement in participant proportions with sufficient MCH knowledge (post-intervention: 80.3% versus pre-intervention: 19.6%, p < 0.001). Attitudes towards healthy MCH behaviors improved post-intervention; 98.7% of women agreed that attending eight or more ANC visits is crucial, compared to 88.1% before intervention (p < 0.001). Additionally, 99.6% of participants recognized a health facility as the best place for ANC post-intervention, compared to 89.9% pre-intervention (p < 0.001). The average number of ANC visits significantly increased from 1.22 to 6.38 (p < 0.001).Conclusion Contextually tailored education delivered by trained CHWS significantly improved maternal health knowledge, attitudes, and ANC attendance among pregnant women in rural Uganda.

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Effectiveness Of a Community Health Worker-Led Education Intervention on Knowledge, Attitude, and Antenatal Care Attendance of Pregnant Women in Eastern Uganda. A Quasi- Experimental Study

Lee,

Kasibante,

Eminai

et al. 2024

Preprint

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Empowering Community Health Workers with Scripted Medicine: A Design Science Research Study (Preprint)

Staehelin,

Schmid,

Gerber

et al. 2024

Preprint

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BACKGROUND The WHO anticipates a shortage of 14 million health workers by 2030, particularly affecting the Global South. Community health workers (CHWs) may mitigate the shortages of professional healthcare workers. Recent studies explore the feasibility and effectiveness of shifting non-communicable disease (NCD) services to CHWs. Challenges such as high attrition rates and variable performance persist due to inadequate organizational support and could hamper such efforts. Research on employee empowerment highlights how organizational structures affect employees’ perception of empowerment and retention. OBJECTIVE Collaboration engineering research offers insights that could help address the structural issues in community-based healthcare and facilitate task-shifting. This study aims to develop Scripted Medicine to empower CHWs to accept broader responsibilities in NCD care. Its objective is to convey relevant medical and counseling knowledge through medical algorithms and ThinkLets (i.e., social scripts). METHODS This study follows a design science research approach to implement a mHealth-supported community-based intervention in two districts of Lesotho. We first develop the medical algorithms and ThinkLets based on insights from collaboration engineering and algorithmic management literature. We then evaluate the designed approach in a field study in the ComBaCaL project. The field study includes ten newly recruited CHWs and spans over two weeks of training and 12 weeks of field experience. <> Following an abductive approach, we analyzed surveys, interviews, and observations to study how Scripted Medicine empowers CHWs to accept broader responsibilities in NCD care. RESULTS Scripted Medicine successfully conveys the required medical and counseling knowledge through medical algorithms and ThinkLets. We find that medical algorithms predominantly influence CHWs’ perception of structural empowerment, while ThinkLets affect their psychological empowerment. The different perceptions between the groups of CHWs from the two districts highlight the importance of considering the cultural and economic context. CONCLUSIONS We propose Scripted Medicine as a novel approach to CHW empowerment inspired by collaboration engineering and algorithmic management. Scripted Medicine broadens the perspective on mHealth-supported community-based healthcare. It emphasizes the need to “script” not only essential medical knowledge but also “script” counseling expertise. These scripts allow CHWs to embed medical knowledge into the social interactions in community-based healthcare. Scripted Medicine empowers CHW to accept broader responsibilities to address the imminent shortage of medical professionals in the Global South.

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Community health worker empowerment through collaborative models with community midwifery

Cited by 2 publications

References 27 publications

Effectiveness Of a Community Health Worker-Led Education Intervention on Knowledge, Attitude, and Antenatal Care Attendance of Pregnant Women in Eastern Uganda. A Quasi- Experimental Study

Effectiveness Of a Community Health Worker-Led Education Intervention on Knowledge, Attitude, and Antenatal Care Attendance of Pregnant Women in Eastern Uganda. A Quasi- Experimental Study

Empowering Community Health Workers with Scripted Medicine: A Design Science Research Study (Preprint)

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