scholarly journals Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Shehla Zaidi ◽  
Abdul Momin Kazi ◽  
Atif Riaz ◽  
Ammarah Ali ◽  
Rabia Najmi ◽  
...  
Keyword(s):  
Focus Group ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers ◽  
Daily Routine ◽  
End User ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Task Technology Fit

BACKGROUND The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. OBJECTIVE Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. METHODS The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. RESULTS Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. CONCLUSIONS The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology.

scholarly journals Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

10.2196/18414 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18414 ◽  
Author(s):  
Shehla Zaidi ◽  
Abdul Momin Kazi ◽  
Atif Riaz ◽  
Ammarah Ali ◽  
Rabia Najmi ◽  
...  
Keyword(s):  
Focus Group ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers ◽  
Daily Routine ◽  
End User ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Task Technology Fit

Background The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology.

scholarly journals Skills2Care: An innovative, cooperative learning programme for community health workers in South Africa

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Therese M. Boulle ◽  
Paul Cromhout ◽  
Khuzwayo August ◽  
Dave Woods
Keyword(s):  
South Africa ◽  
Focus Group ◽  
Cooperative Learning ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Large Numbers ◽  
Cognitive Knowledge

Background: Community health workers (CHWs) hold potential to support universal health coverage and better health for vulnerable communities. They are integral to the re-engineered Primary Health Care (PHC) strategy, introduced in South Africa in 2011. This study focussed on how to train CHWs in large numbers, especially in resource-limited, rural settings. Skills2Care, a method of cooperative learning for CHWS, has been pioneered in the Eastern Cape of South Africa.Aim: To determine whether Skills2Care could improve the cognitive knowledge of CHWs; to understand their response and attitude to the programme; to explore factors that enabled and inhibited learning and to consider its viability as a training method.Setting: Research was conducted in 2019 in the Ngqeleni subdistrict of the O.R. Tambo district, in rural Eastern Cape.Methods: A group-learning model using specifically tailored study modules in booklet format, addressing mother and baby care, was used. A facilitator promoted learning. Knowledge assessment was conducted by pre- and post-study testing using multiple choice questions. Focus group discussions and interviews explored the appropriateness and acceptability of this method, and factors enabling and inhibiting the learning.Results: This method of peer group cooperative learning can significantly increase the cognitive knowledge of CHWs. Test scores indicated a significant (13%) improvement. Focus group discussions indicated that participants valued this method as it increased knowledge and boosted their confidence.Conclusion: This innovative approach to district-based, continuing education suggests that CHWs could be trained in large numbers without the need for additional resources.

scholarly journals Barriers and facilitators to neonatal health and care-seeking behaviours in rural Cambodia: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035449 ◽  
Author(s):  
Gabriella Watson ◽  
Kaajal Patel ◽  
Daly Leng ◽  
Dary Vanna ◽  
Sophanou Khut ◽  
...  
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Barriers And Facilitators ◽  
Neonatal Health ◽  
Care Seeking ◽  
Focus Group Discussions ◽  
Group Discussions

ObjectivesNeonatal mortality remains persistently high in low-income and middle-income countries. In Cambodia, there is a paucity of data on the perception of neonatal health and care-seeking behaviours at the community level. This study aimed to identify influencers of neonatal health and healthcare-seeking behaviour in a rural Cambodian province.DesignA qualitative study using focus group discussions and thematic content analysis.SettingFour health centres in a rural province of Northern Cambodia.ParticipantsTwenty-four focus group discussions were conducted with 85 community health workers in 2019.ResultsCommunity health workers recognised an improvement in neonatal health over time. Key influencers to neonatal health were identified as knowledge, sociocultural behaviours, finances and transport, provision of care and healthcare engagement. Most influencers acted as both barriers and facilitators, with the exception of finances and transport that only acted as a barrier, and healthcare engagement that acted as a facilitator.ConclusionUnderstanding health influencers and care-seeking behaviours is recognised to facilitate appropriate community health programmes. Key influencers and care-seeking behaviours have been identified from rural Cambodia adding to the current literature. Where facilitators have already been established, they should be used as building blocks for continued change.

scholarly journals PERCEPTIONS OF MOTHERS AND CAREGIVERS REGARDING THE DETECTION AND TREATMENT OF SEVERELY MALNOURISHED CHILDREN IN KANCHELE, KALOMO DISTRICT, ZAMBIA

2015 ◽  
Vol 16 (2) ◽  
pp. 98-111 ◽  
Author(s):  
H Khunga ◽  
K J Okop ◽  
Thandi Puoane
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Health Care Facilities ◽  
Health Seeking ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Malnourished Children

Each year, malnutrition accounts for about 50% of the deaths of under-fives in developing countries. In Zambia, about 45% of children under the age of five exhibit stunted growth, mainly due to malnutrition. Early detection of cases by health workers and prompt health-seeking practices at household and community levels can improve the identification and management of malnutrition, and prevent unnecessary deaths. The study provides insights into the perceptions of mothers, caregivers, community members and community health workers regarding the detection, referral and health-seeking practices of malnourished children in Kalomo district of Zambia. This was a qualitative study which explored perceptions and challenges of detection and prompt treatment of malnutrition (kwashiorkor and marasmus) in children under five years of age in the community. Focus group discussions using pictographs were conducted with purposely selected mothers and caregivers of children attending immunization clinics in rural health centres in Zambia. In-depth interviews were also conducted with purposely selected grandparents, community health workers and nutrition advisors to validate the findings obtained from focus group discussions. Data were analysed using thematic analysis. Malnutrition, particularly marasmus, was linked to HIV infection. Barriers to seeking health care for severely malnourished children included beliefs about causes of malnutrition, failure to link malnutrition to poor feeding practices, distance to health care facilities and lack of free feeding schemes for malnourished children. Mothers’ decisions to seek care for malnourished children were influenced largely by grandparents. Increasing awareness about causes, signs and symptoms of malnutrition in this community is needed to improve detection and treatment of malnourished children.

scholarly journals Knowledge, beliefs and attitudes of community health workers about hypertension in the Cape Peninsula, South Africa

Curationis ◽  
2004 ◽  
Vol 27 (1) ◽  
Author(s):  
M.J. Sengwana ◽  
T. Puoane
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Health Promotion ◽  
Focus Group ◽  
Community Health ◽  
Health Workers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Cape Peninsula ◽  
Beliefs And Attitudes

This article explores the perceptions and attitudes of community health workers (CHWs) about hypertension. The level of knowledge of hypertension, as well as their personal attitude towards this is crucial in the style and quality of their interventions. CHWs, whose role in health promotion is being increasingly recognised, can help contain or reduce the prevalence of hypertension by influencing the community to adopt healthy lifestyles. Forty-three CHWs employed by Zanempilo in two study areas, Sites B and C in Khayelitsha in the Cape Peninsula, South Africa, were included in the study. Firstly, focus group discussions were conducted with 17 purposively selected CHWs to explore attitudes, beliefs and perceptions of hypertension. Secondly, interviews were conducted to assess their basic knowledge about causes, prevention and control of hypertension. The focus group discussions revealed that CHWs were uncertain about the causes of hypertension. They also found it difficult to grasp the fact that people without risk factors, such as overweight or a family history of hypertension, could be hypertensive. Many CHWs believe in traditional medicines and home-brewed beer as the best treatment for hypertension. They believe that people who take medical treatment become sicker and that their health deteriorates rapidly. Risk factors of hypertension mentioned during the structured interviews include inheritance, lack of physical activity, consuming lots of salty and fatty food. Conclusions drawn from the findings of the CHWs’ responses highlighted their insufficient knowledge about hypertension as a chronic disease of lifestyle. Meanwhile they are expected to play a role in stimulating community residents’ interest in the broad principle of preventive health maintenance and follow-up. Data obtained from this research can be used for the planning of health-promotion programmes. These should include preventing hypertension and improving primary management of individual sufferers. Because of their working relations and close link with CHWs, community nurses in primary health-care facilities need to recognise these beliefs and attitudes since these may differ from their own.

Unlocking Trust in Community Health Systems: Lessons from the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

2021 ◽  
Author(s):  
Joseph M. Zulu ◽  
Patricia Maritim ◽  
Adam Silumbwe ◽  
Hikabasa Halwiindi ◽  
Patricia Mubita ◽  
...  
Keyword(s):  
Focus Group ◽  
Health Services ◽  
Lymphatic Filariasis ◽  
Health Systems ◽  
Disability Prevention ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Health Systems ◽  
Referral Systems ◽  
Depth Interviews

Background: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHS) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. Methods: Qualitative data was collected through in-depth interviews and focus group discussions (n=45) in February 2020 in Luangwa District. Thirty-one in-depth interviews were conducted with hydrocele patients, CHWs, health workers, traditional leaders and traditional healers. Two focus group discussions were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. Results: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. Conclusion: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

scholarly journals ‘People have started to deliver in the facility these days’: a qualitative exploration of factors affecting facility delivery in Ethiopia

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025516 ◽  
Author(s):  
Zelee Hill ◽  
Yared Amare ◽  
Pauline Scheelbeek ◽  
Joanna Schellenberg
Keyword(s):  
Rural Communities ◽  
Focus Group ◽  
Health Workers ◽  
Facility Delivery ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Factors Affecting ◽  
Positive Experiences ◽  
Qualitative Exploration ◽  
Push And Pull

ObjectivesTo understand the recent rise in facility deliveries in Ethiopia.DesignA qualitative study.SettingFour rural communities in two regions of Ethiopia.Participants12 narrative, 12 in-depth interviews and four focus group discussions with recently delivered women; and four focus group discussions with each of grandmothers, fathers and community health workers.ResultsWe found that several interwoven factors led to the increase in facility deliveries, and that respondents reported that the importance of these factors varied over time. The initial catalysts were a saturation of messages around facility delivery, improved accessibility of facilities, the prohibition of traditional birth attendants, and elders having less influence on deciding the place of delivery. Once women started to deliver in facilities, the drivers of the behaviour changed as women had positive experiences. As more women began delivering in facilities, families shared positive experiences of the facilities, leading to others deciding to deliver in a facility.ConclusionOur findings highlight the need to employ strategies that act at multiple levels, and that both push and pull families to health facilities.

Level of Integration of Community Health Workers in Missouri Health Systems

2016 ◽  
Vol 42 (3) ◽  
pp. 598-604 ◽  
Author(s):  
Darson Rhodes ◽  
Joseph Visker ◽  
Carol Cox ◽  
J. Christian Banez ◽  
Anna Wang
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers

scholarly journals Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi

2018 ◽  
Vol 3 (1) ◽  
pp. e000552 ◽  
Author(s):  
Emily B Wroe ◽  
Elizabeth L Dunbar ◽  
Noel Kalanga ◽  
Luckson Dullie ◽  
Chiyembekezo Kachimanga ◽  
...  
Keyword(s):  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Social Determinants ◽  
Health Workers ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Facility Level

IntroductionPartners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.MethodsWe compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.ResultsIn 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.ConclusionThe Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.

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