Measuring Trust among Frontline Health Workers in Rural Ethiopia

Research on trust, and its influence on teamwork, among health workers in low-resource settings has been understudied. We, therefore, undertook a formative study of trust among three diverse cadres of frontline health workers in Amhara region, Ethiopia. We aimed to develop a comprehensive description of trust in this setting and generate a tool to measure levels of trust within and between cadres. In-depth interviews with 30 frontline workers uncovered a core set of items that seem to define trust in this setting (character/ability/communication), including novel conceptualizations (oneness). Twenty-five items developed from formative data were pilot tested with 92 health workers. The final 10-item scale exhibited strong internal consistency across cadres (alpha>0.83). In support of criterion validity, the scale was positively associated with the sense-of-team scale (p<0.001) and accounted for greater variance in health workers' sense-of-team (Adj.R2 =0.67) than did a composite of single trust items (Adj.R2=0.28). For contrasting group validity, respondents had greater within-group agreement compared to between-group agreement on trust items and displayed higher competence in answering questions about their own cadre. Results demonstrate that the Rural Health Worker Trust Scale can be validly and reliably used to measure trust among diverse cadres. The scale may be used to develop and evaluate trust-building interventions that aim to encourage and sustain collaboration among heterogeneous frontline workers.

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Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling

BMC Health Services Research ◽

10.1186/s12913-020-05914-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Devaki Nambiar ◽

Soumyadeep Bhaumik ◽

Anita Pal ◽

Rajani Ved

Keyword(s):

Blood Pressure ◽

Health Workers ◽

Uttar Pradesh ◽

Poverty Line ◽

Factor Screening ◽

Frontline Workers ◽

Frontline Health Workers ◽

Risk Factor Screening ◽

Lot Quality Assurance Sampling ◽

Screening Coverage

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS). Methods LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined. Results A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level. Conclusion CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups.

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Feasibility and acceptability of computer based online certifcation program for frontline community health workers of Wardha district, India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i2.16411 ◽

2017 ◽

Vol 8 (2) ◽

pp. 82-85

Author(s):

Manoj S Patil ◽

Abhay M Gaidhane ◽

Shital Telrandhe ◽

Quazi Syed Zahiruddin ◽

Navnita Jadhav

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Outreach ◽

Medical Sciences ◽

Frontline Workers ◽

Frontline Health Workers ◽

Computer Based ◽

Health Experts ◽

Strong Agreement

Background: In India, different types of Frontline Community Health Workers are recruited under different departments and health programmes. These include Anganwadi Workers (AWW) under ICDS, ASHA and ANMs under NRHM and health services. Training and recruitment of this staff cadre is an ongoing process. Most of the trainings are aimed at improving the knowledge and skills. A set of test is needed to assess the post training knowledge of trainees which should be feasible, acceptable and easy to administer. Team of Health Experts from DMIMSU, Wardha has developed such specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted to assess the feasibility and acceptability of these tests.Aims and Objectives: Team of Health Experts from DMIMSU,Wardha has developed specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted -1] To assess the feasibility and acceptability of Computer based online certifcation tests for frontline workers. 2] To assess the scope for generalization of these tests to entire frontline health cadre of the district.Materials and Methods: Data was collected from 30 randomly selected Frontline Health Workers who were engaged in Community Outreach Activities/Projects of DMIMS and had undergone trainings and Online Certifcation tests. Questionnaire with Likert type scoring scale was administered. Data was compiled in MS Excel and Weighted Means and proportions of responses towards agreement and disagreement were calculated.Results: Average Weighted Mean was 4.07 showing Strong Agreement towards the feasibility and acceptability. Only 10.3% participants showed disagreement towards the feasibility and acceptability of this test whereas 89.7% participants showed agreement and among them, 47.67% showed strong agreement towards the feasibility and acceptability of this test.Conclusion: These tests were found quite feasible and well accepted by Frontline Health Workers. Similar tests should be made compulsory for all Frontline Health Workers Cadre and their performance in tests should be linked to provisions of incentives and seniority benefits.Asian Journal of Medical Sciences Vol.8(2) 2017 82-85

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Knowledge and Skills Retention Among Frontline Health Workers: Community Maternal and Newborn Health Training in Rural Ethiopia

Journal of Midwifery & Women s Health ◽

10.1111/jmwh.12146 ◽

2014 ◽

Vol 59 (s1) ◽

pp. S21-S31 ◽

Cited By ~ 16

Author(s):

Abebe Gebremariam Gobezayehu ◽

Hajira Mohammed ◽

Michelle M. Dynes ◽

Binyam Fekadu Desta ◽

Danika Barry ◽

...

Keyword(s):

Health Workers ◽

Newborn Health ◽

Maternal And Newborn Health ◽

Health Training ◽

Knowledge And Skills ◽

Rural Ethiopia ◽

Frontline Health Workers ◽

Skills Retention ◽

Maternal And Newborn

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PULSE OXIMETRY IMPLEMENTATION WITH RURAL FRONTLINE HEALTH WORKERS DURING THE OUTPATIENT CARE OF CHILDREN WITH CLINICALLY SUSPECTED PNEUMOCOCCAL PNEUMONIA IN MALAWI: A PROSPECTIVE OBSERVATIONAL STUDY

10.26226/morressier.5731f0d5d462b8029237f952 ◽

2016 ◽

Author(s):

Eric McCollum

Keyword(s):

Observational Study ◽

Pulse Oximetry ◽

Outpatient Care ◽

Pneumococcal Pneumonia ◽

Prospective Observational Study ◽

Health Workers ◽

Frontline Health Workers

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Mothers’ Experiences and Perceptions of Facility-based Delivery Care in Rural Ethiopia

Health Services Insights ◽

10.1177/11786329211017684 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110176

Author(s):

Elin Mordal ◽

Ingrid Hanssen ◽

Andargachew Kassa ◽

Solfrid Vatne

Keyword(s):

Family Involvement ◽

Healthcare Facility ◽

Healthcare Services ◽

Skilled Birth Attendants ◽

Adequate Treatment ◽

Rural Ethiopia ◽

Birth Attendants ◽

Southern District ◽

Depth Interviews ◽

Respectful Care

In Ethiopia, delivery wards are a part of primary healthcare services. However, although the maternal mortality rate is very high, approximately 50% of mothers use skilled birth attendants. This study focused on how women in a rural southern district of Ethiopia experience maternity care offered at the local delivery wards. In this qualitative, exploratory study, 19 women who had given birth in a healthcare facility were interviewed in 2019. Individual in-depth interviews were supplemented with observations conducted at 2 different delivery wards in the same district in 2020. Two main themes emerged from the thematic content analysis: increased awareness and safety were the primary reasons for giving birth at a healthcare facility, and traditions and norms affected women’s birth experiences in public maternity wards. The main shortcomings were a shortage of medicine, ambulance not arriving in time, and lack of care at night. For some women, being assisted by a male midwife could be challenging, and the inability to afford necessary medicine made adequate treatment inaccessible. Providing continuous information gave the women a certain feeling of control. Strong family involvement indicated that collectivistic expectations were key to rural delivery wards. The healthcare system must be structured to meet women’s needs. Moreover, managers and midwives should ensure that birthing women receive high-quality, safe, timely, and respectful care.

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Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community

Qualitative Health Research ◽

10.1177/10497323211003542 ◽

2021 ◽

pp. 104973232110035

Author(s):

Felicia Casanova ◽

Felicia M. Knaul ◽

Natalia M. Rodriguez

Keyword(s):

Breast Cancer ◽

Community Health ◽

Health Care Services ◽

Health Knowledge ◽

Health Workers ◽

Cancer Education ◽

Breast Cancer Diagnosis ◽

South Florida ◽

Theory Approach ◽

Depth Interviews

South Florida agricultural regions, home to Latinx immigrant farmworkers, report higher rates of late-stage breast cancer diagnosis than national, state, and county-level averages. We conducted a community-based qualitative study on the needs, health knowledge gaps, barriers to breast cancer screening, and the role of community health workers (CHWs) in supporting the community’s access to early detection services. We conducted three CHW focus groups (FGs) ( n = 25) and in-depth interviews ( n = 15), two FGs ( n = 18) and in-depth interviews ( n = 3) with farmworker community members, and informal interviews with cancer clinicians ( n = 7). Using a grounded theory approach, five core themes regarding the community’s barriers to accessing health care services emerged: (a) lack of information; (b) social and economic barriers; (c) cultural factors; (d) fears and mistrust; and (e) psychosocial concerns. Findings yield implications for community health practice, the potential impact of CHWs, and the production of breast cancer education to improve health equity along with the care continuum.

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