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

Abstract

Background: Rural Afghan populations have low skilled birth attendance rates and high maternal and infant mortality. Insecurity and armed conflict, geographic barriers, and cultural norms often hinder women's access to facility-based reproductive, maternal, newborn, and child health (RMNCH) services. Community health workers (CHWs) are critical agents for behavioral change in this and similarly fragile settings, where RMNCH information exposure is limited by low literacy and mass media access. We assessed the feasibility and acceptability of a computer tablet-based health video library (HVL) to enhance CHW counseling on RMNCH topics in three rural Afghan districts. Methods: The HVL was introduced by trained CHWs in 10 pilot communities within one rural district in each of Balkh, Herat, and Kandahar provinces. We used a mixed-methods study design to assess exposure to and perception of the HVL 6 months post-introduction. We surveyed married women (n = 473) and men (n = 468) with at least one child under 5 years and conducted in-depth interviews with CHWs and community leaders (shuras and Family Health Action groups) within pilot communities (n = 80). Program improvement needs were summarized using quantitative and qualitative data. Results: Higher proportions of women in Balkh (60.3%) and Herat (67.3%) reported viewing at least one HVL video compared to women in Kandahar (15%), while male HVL exposure was low (8-17%) across all districts. Most HVLexposed clients (85-93% of women and 74-92% of men) reported post-video counseling by CHWs. Nearly all (94-96% of women and 85-92% of men) were very interested in watching videos on other health topics in the future. Participants recommended increasing the number of videos and range of topics, using tablets with larger screens, and translating videos into additional local languages to improve the HVL program.

The role of community health worker-based care in post-conflict settings: a systematic review

“…Other interventions identified in our review included advanced distribution of misoprostol ( Smith et al. , 2014a ; 2014b ); the use of health video libraries for community counselling ( Dal Santo et al. , 2020 ); a combined programme of modern contraceptive use, antenatal care and skilled birthing attendance ( Viswanathan et al.…”

“…Material resources included integrating technology in the care process [e.g. computer tablet-based health video library ( Dal Santo et al. , 2020 )] and offering free care [e.g.…”

“It’s Different Here” Afghan Refugee Maternal Health Experiences in the United States

“…Health providers should consider using visual or audio rather than written material to improve communication and health literacy. A study in Afghanistan found a high satisfaction rate with community health workers who used a computer tablet-based health video library to enhance health counseling sessions [27].…”

Improvement of community health worker counseling skills through early childhood development (ECD) videos, supervision and mentorship: A mixed methods pre-post evaluation from Tanzania

“…A systematic review of CHWs and mobile technology concluded that despite relatively low levels of education and minimal training among a community volunteer cadre, the use of video and other job aids could help to improve their performance in the provision of care [ 5 ]. In addition, the importance of using video demonstration to facilitate learning of new behaviors has been documented [ 19 ].…”

“…It is worth noting that engaging caregivers to discuss how they would undertake nurturing care activities provided an opportunity for self-reflection, problem solving, and the identification of individualized actions. A study on how CHWs used ECD videos in India found the PLOS GLOBAL PUBLIC HEALTH tools helped them to better engage and educate clients [19]. Another study in India showed improved CHW performance through use of videos to engage women in dialogue to practice healthy behaviors [12].…”