scholarly journals ‘Do you trust those data?’—a mixed-methods study assessing the quality of data reported by community health workers in Kenya and Malawi

2020 ◽  
Vol 35 (3) ◽  
pp. 334-345 ◽  
Author(s):  
Regeru Njoroge Regeru ◽  
Kingsley Chikaphupha ◽  
Meghan Bruce Kumar ◽  
Lilian Otiso ◽  
Miriam Taegtmeyer
Keyword(s):  
Mixed Methods ◽  
Data Quality ◽  
Community Health ◽  
Health Workers ◽  
Calculated Data ◽  
Mixed Methods Study ◽  
Quality Data ◽  
Growth Monitoring ◽  
Health Coverage ◽  
Quality Of Data

Abstract High-quality data are essential to monitor and evaluate community health worker (CHW) programmes in low- and middle-income countries striving towards universal health coverage. This mixed-methods study was conducted in two purposively selected districts in Kenya (where volunteers collect data) and two in Malawi (where health surveillance assistants are a paid cadre). We calculated data verification ratios to quantify reporting consistency for selected health indicators over 3 months across 339 registers and 72 summary reports. These indicators are related to antenatal care, skilled delivery, immunization, growth monitoring and nutrition in Kenya; new cases, danger signs, drug stock-outs and under-five mortality in Malawi. We used qualitative methods to explore perceptions of data quality with 52 CHWs in Kenya, 83 CHWs in Malawi and 36 key informants. We analysed these data using a framework approach assisted by NVivo11. We found that only 15% of data were reported consistently between CHWs and their supervisors in both contexts. We found remarkable similarities in our qualitative data in Kenya and Malawi. Barriers to data quality mirrored those previously reported elsewhere including unavailability of data collection and reporting tools; inadequate training and supervision; lack of quality control mechanisms; and inadequate register completion. In addition, we found that CHWs experienced tensions at the interface between the formal health system and the communities they served, mediated by the social and cultural expectations of their role. These issues affected data quality in both contexts with reports of difficulties in negotiating gender norms leading to skipping sensitive questions when completing registers; fabrication of data; lack of trust in the data; and limited use of data for decision-making. While routine systems need strengthening, these more nuanced issues also need addressing. This is backed up by our finding of the high value placed on supportive supervision as an enabler of data quality.

scholarly journals Distrusting community health workers with confidential health information: a convergent mixed-methods study in Swaziland

2017 ◽  
Vol 32 (6) ◽  
pp. 882-889 ◽  
Author(s):  
Pascal Geldsetzer ◽  
Maria Vaikath ◽  
Jan-Walter De Neve ◽  
Thomas J Bossert ◽  
Sibusiso Sibandze ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Health Information ◽  
Community Health Workers ◽  
Health Workers ◽  
Mixed Methods Study

scholarly journals Household coverage, quality and costs of care provided by community health worker teams and the determining factors: findings from a mixed methods study in South Africa

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035578
Author(s):  
Jane Goudge ◽  
Julia de Kadt ◽  
Olukemi Babalola ◽  
Michel Muteba ◽  
Yu-hwei Tseng ◽  
...  
Keyword(s):  
South Africa ◽  
Mixed Methods ◽  
Community Health ◽  
Health Workers ◽  
Household Survey ◽  
Health Coverage ◽  
Clinic Staff ◽  
Vulnerable Communities ◽  
Senior Nurse ◽  
Local Facility

ObjectiveCommunity health workers (CHWs) are undertaking more complex tasks as part of the move towards universal health coverage in South Africa. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle with insufficient supervision. In this paper, we assess coverage (proportion of households visited by a CHW in the past year and month), quality of care and costs of the service provided by CHW teams with differing configurations of supervisors, some based in formal clinics and some in community health posts.ParticipantsCHW, their supervisors, clinic staff, CHW clients.MethodsWe used mixed methods (a random household survey, focus group discussions, interviews and observations of the CHW at work) to examine the performance of six CHW teams in vulnerable communities in Sedibeng, South Africa.ResultsA CHW had visited 17% of households in the last year, and we estimated they were conducting one to two visits per day. At household registration visits, the CHW asked half of the questions required. Respondents remembered 20%–25% of the health messages that CHW delivered from a visit in the last month, and half of the respondents took the action recommended by the CHW. Training, supervision and motivation of the CHW, and collaboration with other clinic staff, were better with a senior nurse supervisor. We estimated that if CHW carried out four visits a day, coverage would increase to 30%–90% of households, suggesting that some teams need more CHW, as well as better supervision.ConclusionHousehold coverage was low, and the service was limited. Support from the local facility was key to providing a quality service, and a senior supervisor facilitated this collaboration. Greater investment in numbers of CHW, supervisors, training and equipment is required for the potential benefits of the programme to be delivered.

scholarly journals Evaluating the Association of State Regulation of Community Health Workers on Adoption of Standard Roles, Skills, and Qualities by Employers in Select States: A Mixed Methods Study

2021 ◽  
Author(s):  
Tammie M. Jones ◽  
Alex Schulte ◽  
Suhashini Ramanathan ◽  
Meron Assefa ◽  
Srilatha Rebala ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Health Workers ◽  
State Regulation ◽  
Mixed Methods Study ◽  
Certification Programs ◽  
Job Ads ◽  
The Relationship

Abstract BackgroundThe occupation of Community Health Worker (CHW) has evolved to support community member navigation of complex health and social systems. The U.S. Bureau of Labor Statistics formally recognized the occupation of Community Health Worker (CHW) in 2009. Since then, various national and state level efforts to professionalize the occupation have been undertaken. The Community Health Workers Core Consensus (C3) project released a set of CHW roles and competency recommendations meant to provide evidence-based standards for CHW roles across work settings. Some states have adopted the recommendations, however, there are a variety of approaches regarding the regulation of the occupation. As of 2020, 19 U.S. states have implemented voluntary statewide CHW certification programs. The purpose of this study was to explore the relationship between state regulation of CHWs and adoption of standard roles, skills, and qualities by employers in select states.MethodsThis mixed methods study used purposive sampling of job ads for CHWs posted by employers from 2017-2020 in select states. Natural language processing was used to extract content from job ads and preprocess the data for statistical analysis. ANOVA, chi-square analysis, and MANOVA was used to test hypotheses related to the relationship between state regulation of CHWs and differences in skills, roles, and qualities employers seek based seniority of state regulatory processes and employer types.ResultsWe observe that the mean job ads with nationally identified roles (F(6, 80549) = 109.43, p = 0.000), skills (F(6, 80549) = 136.13, p = 0.000), and qualities (F(6, 80549) = 257.29, p = 0.000) included varies significantly between individual states, by state type, and by employer type. ConclusionsEmployment of CHWs is increasing as a means to provide culturally competent care, address the social determinants of health, and improve access to health and social services for members of traditionally underserved communities. Employers in states with CHW certification programs were associated with greater adoption of occupational standards set by state and professional organizations. Wide adoption of such standards may improve recognition of the CHW workforce as a valuable resource in addressing the needs of marginalized and difficult to serve groups.

scholarly journals Evaluating the association of state regulation of community health workers on adoption of standard roles, skills, and qualities by employers in select states: a mixed methods study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tammie M. Jones ◽  
Alex Schulte ◽  
Suhashini Ramanathan ◽  
Meron Assefa ◽  
Srilatha Rebala ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Health Workers ◽  
State Regulation ◽  
Mixed Methods Study ◽  
Certification Programs ◽  
Job Ads ◽  
The Relationship

Abstract Background The occupation of community health worker (CHW) has evolved to support community member navigation of complex health and social systems. The U.S. Bureau of Labor Statistics formally recognized the occupation of community health worker (CHW) in 2009. Since then, various national and state efforts to professionalize the occupation have been undertaken. The Community Health Workers Core Consensus (C3) project released a set of CHW roles and competency recommendations meant to provide evidence-based standards for CHW roles across work settings. Some states have adopted the recommendations; however, there are a variety of approaches regarding the regulation of the occupation. As of 2020, 19 U.S. states have implemented voluntary statewide CHW certification programs. The purpose of this study was to explore the relationship between state regulation of CHWs and adoption of standard roles, skills, and qualities by employers in select states. Methods This mixed methods study used purposive sampling of job ads for CHWs posted by employers from 2017 to 2020 in select states. Natural language processing was used to extract content from job ads and preprocess the data for statistical analysis. ANOVA, chi-square analysis, and MANOVA was used to test hypotheses related to the relationship between state regulation of CHWs and differences in skills, roles, and qualities employers seek based on seniority of state regulatory processes and employer types. Results The mean job ads with nationally identified roles, skills, and qualities varies significantly by state policy type (F(2, 4801) = 26.21) and by employer type (F(4, 4799) = 69.08, p = 0.000). Conclusions Employment of CHWs is increasing to provide culturally competent care, address the social determinants of health, and improve access to health and social services for members of traditionally underserved communities. Employers in states with CHW certification programs were associated with greater adoption of occupational standards set by state and professional organizations. Wide adoption of such standards may improve recognition of the CHW workforce as a valuable resource in addressing the needs of high-need and marginalized groups.

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