Towards an Integrated mHealth Platform for Community-based Maternity Health Workers in Low-Income Communities

BACKGROUND Digital technology is increasingly being used to enhance various aspects of health care. In the area of community-based, it is important to understand the circumstances and challenges of deploying this technology to solve health care issues. OBJECTIVE To develop a tool to support communication and care coordination efforts of community-based prenatal care coordinators who serve low-income pregnant women, and to uncover barriers and facilitators to the tool's use before a wide-scale pilot study. METHODS We devised a four-step development and evaluation process: (1) state-wide stakeholder collaboration to conceptualize the system; (2) expert panel to identify key functionalities to support care coordination and communication between community-based health workers and pregnant women; (3) iterative and incremental development using agile design and software development; and (4) two evaluations to test usability and user acceptance of the system using real-life scenarios. RESULTS Participants found the web app easy to use and envisioned many benefits of using it in their practices. From the qualitative data, we uncovered many barriers around implementation of the technology, including care coordinator’s lack of motivation to participate in the study and provide feedback on the system design. CONCLUSIONS This research provides a methodology for development and deployment of a web-delivered technology in community-based setting. In addition, the research provides insights on real-life challenges of deploying a technology-based solution in community-based settings.

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Management of severe acute malnutrition in low-income and middle-income countries

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-306026 ◽

2014 ◽

Vol 100 (3) ◽

pp. 283-287 ◽

Cited By ~ 41

Author(s):

Indi Trehan ◽

Mark J Manary

Keyword(s):

Low Income ◽

Rural Areas ◽

Health Workers ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Community Based ◽

Middle Income ◽

Middle Income Countries ◽

Environmental Enteropathy ◽

Fortified Milk

Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.

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Incidence and etiology of omphalitis in Pakistan: a community-based cohort study

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1229 ◽

2011 ◽

Vol 5 (12) ◽

pp. 828-833 ◽

Cited By ~ 14

Author(s):

Fatima Mir ◽

Shiyam Sundar Tikmani ◽

Sadia Shakoor ◽

Haider Javed Warraich ◽

Shazia Sultana ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Low Income ◽

Health Workers ◽

Low Cost ◽

Clinical Signs ◽

Community Settings ◽

Community Based ◽

Neonatal Deaths ◽

Live Births ◽

Group B

Introduction: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Methodology: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Results: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). Conclusions: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.

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Lay Health Workers in Community-based Care and Management of Dementia: a ‘Pre’ and ‘Post’ Pilot Intervention Study in Southwestern Uganda

10.21203/rs.3.rs-827744/v1 ◽

2021 ◽

Author(s):

Christine K Karungi ◽

Edith K Wakida ◽

Godfrey Z Rukundo ◽

Zohray M Talib ◽

Jessica E Haberer ◽

...

Keyword(s):

Low Income ◽

Intervention Study ◽

Health Workers ◽

Qualitative Assessment ◽

Lay Health Workers ◽

Community Based ◽

People With Dementia ◽

Specific Support ◽

Pilot Intervention ◽

Southwestern Uganda

Abstract Background: The global need for efficient and cost-effective use of healthcare resources in low-income countries has led to the introduction of lay health workers (LHWs) as a link of the community to the formal health care services, especially in remote areas. As such, the LHWs perform a variety of tasks such as patient care, education, support for care delivery, and social support across all disease types. However, little is known about their ability to support dementia care and management in the community. Purpose: The goal of the pilot intervention study was to evaluate the ability of LHWs in rural southwestern Uganda to support community-based care and management for people with dementia. Methods: This was a ‘pre’ and ‘post’ pilot intervention study which involved a qualitative assessment of LHWs’ knowledge on community-based management and care for people with dementia. The pilot intervention focused on four core competency domains in the WHO dementia toolkit. It began with a five-day training of the LHWs, followed by eight weeks of implementation of knowledge and skills gained during the training, and an evaluation of their experiences. Analysis focused on apriori themes i.e., needs assessment, early detection and management, community engagement, and support for people with dementia; as well as evaluation of the eight-weeks implementation. Results: Before the training, the LHWs did not know much about dementia and provided no dementia-specific support in the community. Activities were limited to general support, including sanitation, nutrition, and health education. After the training, LHWs had a basic understanding of dementia and began sensitizing their communities. They provided dementia-specific support, although they had challenges in differentiating the signs of early dementia from superstitious beliefs. They felt more comfortable in handling people with dementia and reported a notable change in the attitude of family members towards people with symptoms of dementia. Conclusion: Results from the pilot intervention study showed that, with enhanced capacity, LHWs may be able to support community-based management for people with dementia. A larger study is needed to confirm these findings and further assess effectiveness of the LHWs’ skills.

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Multilevel Pathways of Colorectal Cancer Screening Among Low-Income Vietnamese Americans: A Structural Equation Modeling Analysis

Cancer Control ◽

10.1177/10732748211011077 ◽

2021 ◽

Vol 28 ◽

pp. 107327482110110

Author(s):

Grace X. Ma ◽

Lin Zhu ◽

Timmy R. Lin ◽

Yin Tan ◽

Phuong Do

Keyword(s):

Health Beliefs ◽

Low Income ◽

Self Efficacy ◽

Limited English Proficiency ◽

Structural Equation ◽

Vietnamese Americans ◽

Equation Modeling ◽

Community Based ◽

Related Factors ◽

Crc Screening

Background: Colorectal cancer (CRC) disproportionately affects Vietnamese Americans, especially those with low income and were born outside of the United States. CRC screening tests are crucial for prevention and early detection. Despite the availability of noninvasive, simple-to-conduct tests, CRC screening rates in Asian Americans, particularly Vietnamese Americans, remain suboptimal. The purpose of this study was to evaluate the interplay of multilevel factors – individual, interpersonal, and community – on CRC screening behaviors among low-income Vietnamese Americans with limited English proficiency. Methods: This study is based on the Sociocultural Health Behavior Model, a research-based model that incorporates 6 factors associated with decision-making and health-seeking behaviors that result in health care utilization. Using a community-based participatory research approach, we recruited 801 Vietnamese Americans from community-based organizations. We administered a survey to collect information on sociodemographic characteristics, health-related factors, and CRC screening-related factors. We used structural equation modeling (SEM) to identify direct and indirect predictors of lifetime CRC screening. Results: Bivariate analysis revealed that a greater number of respondents who never screened for CRC reported limited English proficiency, fewer years of US residency, and lower self-efficacy related to CRC screening. The SEM model identified self-efficacy (coefficient = 0.092, P < .01) as the only direct predictor of lifetime CRC screening. Educational attainment (coefficient = 0.13, P < .01) and health beliefs (coefficient = 0.040, P < .001) had a modest significant positive relationship with self-efficacy. Health beliefs (coefficient = 0.13, P < .001) and educational attainment (coefficient = 0.16, P < .01) had significant positive relationships with CRC knowledge. Conclusions: To increase CRC screening uptake in medically underserved Vietnamese American populations, public health interventions should aim to increase community members’ confidence in their abilities to screen for CRC and to navigate associated processes, including screening preparation, discussions with doctors, and emotional complications.

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Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00802-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Sonja Klingberg ◽

Esther M. F. van Sluijs ◽

Stephanie T. Jong ◽

Catherine E. Draper

Keyword(s):

South Africa ◽

Health Care ◽

Public Sector ◽

Health Workers ◽

Care Facility ◽

Health Care Facility ◽

Preschool Age ◽

Primary Health Care Facility ◽

Community Based ◽

Primary Health

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

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The implementation of a mobile application to support community-based health workers

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.051 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A C F Martins ◽

P L Pereira ◽

A C C N Mafra ◽

J L Miraglia ◽

C N Monteiro ◽

...

Keyword(s):

Health Care ◽

Mobile Application ◽

Total Population ◽

Health Workers ◽

Data Entry ◽

Population Data ◽

Administrative Staff ◽

Economic Data ◽

Process Change ◽

Community Based

Abstract Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

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Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽

10.3390/nu13020367 ◽

2021 ◽

Vol 13 (2) ◽

pp. 367

Author(s):

Pilar Charle-Cuéllar ◽

Noemí López-Ejeda ◽

Mamadou Traore ◽

Adama Balla Coulibaly ◽

Aly Landouré ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Community Intervention ◽

Health Workers ◽

Acute Malnutrition ◽

Control Group ◽

Supportive Supervision ◽

Supervision Group ◽

Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

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“I Want to Advocate for Our Kids”: How Community-Based Organizations Broker College Enrollment for Underrepresented Students

Education and Urban Society ◽

10.1177/00131245211004565 ◽

2021 ◽

pp. 001312452110045

Author(s):

Irma Y. Ramirez

Keyword(s):

High School Students ◽

Low Income ◽

Students Of Color ◽

College Enrollment ◽

Underrepresented Students ◽

School Students ◽

Community Based ◽

Community Based Organizations ◽

Student College ◽

Community Based Organization

This exploratory study examines the role community-based organizations have in bridging low-income students of color to postsecondary institutions. Data came from interviews with organization staff, high school students, and college students associated with three distinct community-based organizations located in a mid-size city. The findings suggest that organization staff are well-positioned in youth, academic, and community social networks. Staff become social brokers across these networks through three steps: cultivating authentic and safe relationships, lessons from students, and becoming advocates. Community-based organization staff strategically advocate for underrepresented student college enrollment and admissions by serving as social brokers between students, schools, and their communities.

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