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

Abstract

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.