The home visit communication skills inventory: Piloting a tool to measure community health worker fidelity to training in rural South Africa

Abstract

Community-based home visiting programs using community health workers (CHWs) have become popular modes of delivering health care services, especially in settings where health workers are overburdened and resources are limited. Yet, little is known about the processes that shape effective implementation in low-resource settings, and whether these processes adhere to home visitors' training. This study used the newly-developed Home Visit Communication Skills Inventory (HCSI) to explore the delivery of a CHW program in rural South Africa. Routine home visits from CHWs to their maternal care clients were audio-recorded with consent, and later transcribed and translated into English. The HCSI, devised and piloted using existing frameworks and program-specific training components, consisted of 21 items covering domains related to active listening, active delivery, and active connecting, and was used to score English transcripts of the home visits. The HCSI was used to generate general frequencies and aggregate scores for each CHW. Eighty-four home visits by 14 CHWs showed a diverse application of communication skills. Active listening and active delivery were common, with fewer instances of active connecting observed. Practices disaggregated by CHW showcased varying strengths by an individual. In reviewing visit characteristics, longer average visit duration was significantly correlated with the presence of multiple types of active connecting skills.While technical skills were widely observed, fewer CHWs engaged in more complex "connecting" skills. The HCSI is a feasible, low-cost, and practical way to describe home visit fidelity among CHWs. Audio-based checklists can be used to describe fidelity to a model in the absence of additional supervisory resources. K E Y W O R D S communication skills, checklist development, community health workers (CHWs), home visiting, rural health, South Africa

Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural South African home visiting program

“…These findings fill some gaps in concurrent research published by our team, with the Enable program, on MM-client relationships [25]. Our team obtained consent from clients and MMs to audio-record individual home visits with 85 clients, and analyzed recordings using a novel communication skills checklist capturing existing communication skills.…”

“…This study was descriptive in nature and utilized semistructured qualitative interviews with pregnant women and recently delivered mothers who were clients of the Enable Mentor Mother program, further referred to as Enable. This study was linked to a larger study of the implementation of Enable during its first three years, part of ongoing efforts to strengthen the quality of care delivered to mothers and infants in the region where Enable operates [25,26]. The O.R.…”

“…MMs recruit and follow-up on pregnant women, as well as specifically targeting families with underweight children, to provide supportive, preventive care in the home for up to five years. While Enable adheres to Philani's model of intervention training and content, the program was adapted to be a "social franchise" of the original model, in which a model is applied in a new setting, supervised and implemented by a different organization [25]. While a MM may have up to 50 or 60 maternal clients, each client is enrolled and visited by only one MM, although these visits occasionally involve supervisors or program coordinators.…”

Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa

“…Laurenzi et al piloted an assessment tool with some similarity to the tool we have assessed in our study. This Home Visit Communication Skills Inventory, a 21-item checklist, assessed only the communication skills (including domains on active listening, active delivery, and active connecting) of CHWs who provide comprehensive care, in South Africa ( 21 ). The Inventory scored audio-recorded and transcribed communication between the CHW and householder(s) during home visits.…”

How nursing science builds from global evidence

“…From Brazil, the paper by da Silva, de Fátima, Moreira, Arthur, and de Souza (), on a randomized‐controlled trial of nursing case management for people with hypertension in primary care, exemplifies a nursing role in public health that is not common in the United States. Another example is the paper by Laurenzi et al (), which presents the home visit skills inventory to evaluate the fidelity of home visits by community health workers in rural South Africa.…”