Community health officer: the concept of mid-level health care providers

Desai, Shrikant; Bishnoi, Ravin Kumar; Punjot, Pankaj

doi:10.18203/2394-6040.ijcmph20201483

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…Therefore, we will incorporate midlevel health care providers as regular intervention moderators but will invite obstetrician-gynecologists and pediatricians to attend certain sessions to respond to participant questions and provide advice. Our selection of community health officers for this role is supported by their primary roles within Ayushman Bharat, the flagship scheme of the Government of India to achieve comprehensive universal health coverage, and the National Digital Health Mission [ 50 , 51 ]. We will also ensure that all moderators are women.…”

Section: Discussionmentioning

confidence: 99%

A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study

Ayadi¹,

Duggal²,

Bagga³

et al. 2022

JMIR Form Res

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Background Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data. Results The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ≥3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies.

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Section: Discussionmentioning

confidence: 99%

A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study

Ayadi¹,

Duggal²,

Bagga³

et al. 2022

JMIR Form Res

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“…The tool has been designed for use by designers and developers to understand the needs and workflows of mHealth system end users in primary health care—community health workers, mid-level providers, and primary care physicians in LMIC settings. In India, these end users correspond to accredited social health activists—village-level community health workers [ 61 ], auxiliary nurse midwives—community health nurse midwives [ 61 ], community health officers—a cadre of mid-level health providers [ 62 ], and medical officers—graduate medical doctors based in primary or secondary health centers [ 63 ]. All of them have mixed clinical and public health responsibilities; some of them are responsible for program implementation and monitoring, as well.…”

Section: The Vinyasa Toolmentioning

confidence: 99%

The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems

Thomas,

Kalidindi,

Waghmare

et al. 2023

JMIR Form Res

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Background mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users’ perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system’s users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system—the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption.

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“…Moreover, the Government of India developed a constructed role for registered nurse practitioners (RNPs) as community health officers (CHOs), which could be achieved after participating in a six-month training program. These CHOs are scheduled to provide healthcare services, leadership, supervision, and management and play a dynamic role in India's healthcare system [45].…”

Section: Midwifery Practices In Indiamentioning

confidence: 99%

Utilizing Midwifery-Led Care Units (MLCU) for Enhanced Maternal and Newborn Health in India: An Evidence-Based Review

Podder¹,

Bhardwaj²,

Siddiqui³

et al. 2023

Cureus

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The allocation of the midwife-led care unit (MLCU), a midwifery-led care model in which midwives carry out eminent roles to enrich maternal and newborn outcomes with minimal standard interventions, has appeared to be productive in furthering the quality of care and positive childbirth experiences. In the present article, we review the investments needed in MLCUs for their inclusion into the public health system by describing their advantages, the latest trends in maternal mortality, the roles of midwives, the relevant background, and the current advances in midwifery practices in India. Midwifery-led care is directed by a philosophy that considers pregnancy and childbirth as normal physiological events for women. Making use of a midwife, especially in low-risk pregnancies, extends satisfactory and cost-effective care. The Government of India has begun to introduce midwifery services to the country to improve the quality, righteousness, and worthiness in the provision of care and to offload higher-level hospitals. The year 2020 was designated as the "Year of the Nurse and the Midwife" by the WHO, highlighting the importance of nurses' and midwives' roles in sustaining quality health care. Further, the acceptability among clinicians and the public is crucial for the future advancement and implementation of MLCUs in India.

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Community health officer: the concept of mid-level health care providers

Cited by 10 publications

References 10 publications

A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study

A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study

The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems

Utilizing Midwifery-Led Care Units (MLCU) for Enhanced Maternal and Newborn Health in India: An Evidence-Based Review

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