Adapting a health video library for use in Afghanistan: provider-level acceptability and lessons for strengthening operational feasibility

Abstract

Background: Community health workers (CHWs) in Afghanistan are a critical care extender for primary health services, including reproductive, maternal, neonatal, and child health (RMNCH) care. However, volunteer CHWs face challenges including an ever-expanding number of tasks and insufficient time to conduct them. We piloted a health video library (HVL) intervention, a tablet-based tool to improve health promotion and counseling by CHWs. We qualitatively assessed provider-level acceptability and operational feasibility. Methods: CHWs implemented the HVL pilot in three rural districts of Balkh, Herat, and Kandahar provinces. We employed qualitative methods, conducting 47 in-depth interviews (IDIs) with male and female CHWs and six IDIs with community health supervisors. We used semi-structured interview guides to explore provider perceptions of program implementation processes and solicit feedback on how to improve the HVL intervention to inform scaleup. We conducted a thematic analysis. Results: CHWs reported that the HVL increased time efficiencies, reduced work burden, and enhanced professional credibility within their communities. CHWs felt video content and format were accessible for low literacy clients, but also identified challenges to operational feasibility. Although tablets were considered easy-to-use, certain technical issues required continued support from supervisors and family. Charging tablets was difficult due to inconsistent electricity access. Although some CHWs reported reaching most households in their catchment area for visits with the HVL, others were unable to visit all households due to sizeable populations and gender-related barriers, including women's limited mobility.

Impacts of Technology Use on the Workload of Registered Nurses: A Scoping Review

“… 10 Clinical efficiency, cost-effectiveness, and improved treatments are some of the benefits of Virtual Communication technologies. Nurses working in rural areas may contact experienced urban nurses through Virtual Communication technologies to seek advice that may help to decrease their workload 34 Lack of Virtual Communication training could increase nursing workload. 10 50% of Virtual Communication technologies showed positive reduction in the workload of nurses 34 , 35 and 50% described an increase.…”

“…40% of the articles found that providing proper education and upgrading the knowledge of nurses and the target population were fundamental facilitators for the technology use by nurses. 5 , 11 , 14 , 16 - 18 , 22 , 24 , 26 , 29 , 30 , 34 , 37 , 39 , 40 Mills et al 22 highlighted proper training as a facilitator of computer use by nurses especially in rural areas where training opportunities are more scarce than in urban areas. To reduce workload efforts, nurses must receive sufficient training to use the technology as to limit the amount of additional time necessary for self-learning.…”

“…Nurses working in rural areas may contact experienced urban nurses through Virtual Communication technologies to seek advice that may help to decrease their workload 34 Lack of Virtual Communication training could increase nursing workload. 10 50% of Virtual Communication technologies showed positive reduction in the workload of nurses 34,35 and 50% described an increase. 10,17 Teleconsultation is another type of Virtual Communication reported by Opoku et al 17 In this study, community health nurses (CHNs) were trained to contact a teleconsultation center with their mobile phones whenever they faced any problem.…”

“…Many articles highlighted challenges due to nursing and healthcare workforce shortages which were amplified in rural and remote areas. 12,15,17,26,34,35,38,[40][41][42][43] Lack of staff in rural areas has a direct impact on the increase of nurses' workload in these areas because the ratio of patients to nurses may be higher resulting in nurses in rural areas having to care for more patients. 25,26,35,40 Lack of healthcare resources and geographical isolation may limit patients in rural areas, particularly the older adults, to adequately benefit from home healthcare technologies.…”

The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon

“…Several studies have shown that mobile ICTs can improve the performance of CHAs in their ability to perform health promotion, collect and report timely information regarding family health, provide health services such as vaccines, and refer families to appropriate local health services (3,(47)(48)(49)(50)(51)(52)(53). Additionally, when a mobile ICT tools are used by a CHA, the device can increase the confidence the caregivers have in the messages being transmitted and increase the confidence the CHAs have in their own work (47,48,51,52,(54)(55)(56). Through implementation science, innovations in mobile ICTs and strategies for child health and development can be extended to low resource settings to empower local actors and spread the benefits of advancements in technology (3,50).…”