Evaluation of an Interactive Electronic Health Education Tool in Rural Afghanistan

Abstract

Introduction: Low education levels may limit community-based health worker (CHW) efforts in rural Afghanistan. In 2004, LeapFrog Enterprises and the United States Department of Health and Human Services developed the Afghan Family Health Book (AFHB), an interactive, electronic picture book, to communicate public health messages in rural Afghanistan. Changes in health knowledge among households exposed to the AFHB vs. CHWs were compared.Methods: From January–June 2005, baseline and follow-up panel surveys were administered in Pashto-speaking Laghman and Dari-speaking Kabul provinces. Within each province, an AFHB and a CHW district were randomly sampled using a stratified, 2-staged cluster sample design (total 98 clusters and 3,372 households). Surveys tested knowledge of 17 health domains at baseline and on follow-up at three months. For each domain, multivariate logistic regression was used to assess the effect of the AFHB on follow-up pass rates, controlling for demographics and differences in baseline knowledge.Results: Both AFHB and CHW resulted in statistically significant changes in pass rates on follow-up, although there were greater gains among AFHB users for five domains among Pashto-speakers (micronutrients, malaria, sexually transmitted diseases, postpartum care, and breast-feeding) and seven domains among Dari-speakers (diet, malaria, mental health, birth-spacing, and prenatal/neonatal/postpartum care). Community-based health workers effected greater knowledge gains only for the Dari breast-feeding module. Participants favored CHW over the AFHB, which they found poorly translated and difficult to use.Conclusions: The AFHB has potential to improve public health knowledge among rural Afghans. Future efforts may benefit from involvement of local health agencies and the integration of interactive technology with traditional CHW approaches.

Understanding care seeking behavior for reproductive tract infections among Afghan women: A cross-sectional study

“…A structured questionnaire was developed in English, drawing from the standard anamnestic questionnaires conventionally used in the clinics where the study was conducted, and also from peerreviewed studies, in order to maximize comprehensiveness and comparability [2,9,10,[15][16][17][18]. Subsequently, a focus group of four gynecology and obstetrics specialists, two generalist medical doctors, and two infectious disease experts reviewed the questionnaire, which was then translated into Pashto and Dari, in order to administer it in the native language of participants [19]. Finally, the questionnaire was preliminarily tested on ten women which respected the inclusion criteria, and possible critical points were corrected.…”

Multisector nutrition gains amidst evidence scarcity: scoping review of policies, data and interventions to reduce child stunting in Afghanistan

“…Most studies explicitly targeted children under 5 or 2 years of age and studies of household interventions specifically targeted women and young children. Interventions ranged from nutrition awareness and health promotion activities [62,63,75,79], micronutrient deficiency treatment or prevention [50,[65][66][67]80], malnutrition treatment or prevention [68, 70-72, 77, 78], and delivery or modelling of a package of community and facility-based interventions, including multisectoral approaches [64,69,74,76,81].…”

“…Nutrition awareness is often promoted through campaigns on different topics such as breastfeeding, hygiene, growth monitoring and complementary feeding at group education sessions [63,71,81], training for women and households participating in kitchen gardens and select agriculture activities [81], and other targeted projects. These tend to be topic and agenda specific by project.…”

“…Almost all interventions included an education component, with four studies also focused on raising awareness and promoting health and nutrition messages. These were done through group education for mothers on child growth charts [62], interactive electronic books with public health messages [63], a nutrition and hygiene awareness pilot as part of an unconditional cash transfer project [79], and brochures on IYCF best practices for newborns [75]. These nutrition awareness programmes all included mothers of young children as the target audience, despite pilot study findings of additional benefit in targeting men or mothers-in-law (or other influential family members) with tailored messages [79].…”

Feasibility and acceptability of a video library tool to support community health worker counseling in rural Afghan districts: a cross-sectional assessment

“…In Afghanistan, the United States Agency for International Development (USAID)-funded Helping Mothers and Children Thrive in Afghanistan (HEMAYAT) project aims to reduce maternal and child mortality in part by increasing RMNCH service demand within communities [25]. Inspired by the Family Health Book Program [26], in which audiovisual devices augmented household adult literacy and heath training, the health video library (HVL) activity was pilot-tested in three rural Afghan districts beginning in July, 2017 through a collaborative effort by the Ministry of Public Health (MoPH) and HEMAYAT. The HVL program uses short educational videos portraying specific health topics to support CHW counseling, with the aim of improving RMNCH knowledge and practices among community members.…”