Formative evaluation of a training intervention for community health workers in South Africa: A before and after study

Abstract

BackgroundCommunity Health Workers (CHWs) have a crucial role in improving health in their communities and their role is being expanded in many parts of the world. However, the effectiveness of CHWs is limited by poor training and the education of CHWs has received little scientific attention.MethodsOur study was carried out in two districts of KwaZulu-Natal, South Africa. We developed and piloted an inexpensive (two day) training intervention covering national government priorities: HIV/AIDS, sexually transmitted disease and Tuberculosis; and Women’s Sexual and Reproductive Health and Rights. Sixty-four CHWs consented to participate in the main study which measured knowledge gains using a modified Solomon design of four different testing schedules to distinguish between the effects of the intervention, testing and any interaction between intervention and testing. We also measured confidence, satisfaction and costs.ResultsFollowing the training intervention, improvements in knowledge scores were seen across topics and across districts. These changes in knowledge were statistically significant (p<0.001) and of large magnitude (over 45 percentage points or four standard deviations). However, the CHWs assigned to the test-test-train schedule in one district showed high gains in knowledge prior to receiving the training. All CHWs reported high levels of satisfaction with the training and marked improvements in their confidence in advising clients. The training cost around US$48 per CHW per day and has the potential to be cost-effective if the large gains in knowledge are translated into improved field-based performance and thus health outcomes.ConclusionTraining CHWs can result in large improvements in knowledge with a short intervention. However, improvements seen in other studies could be due to test ‘reactivity’. Further work is needed to measure the generalisability of our results, retention of knowledge and the extent to which improved knowledge is translated into improved practice.

The Effectiveness Of Video-Online Education On Cadres’ Knowledge And Attitude About The Importance Of Human Immunodeficiency Virus (HIV) Testing In Public Health Center

“…Training can be an intervention choice to increase knowledge and with training it can increase the confidence of officers to provide advice to people at risk of HIV. Training programs for cadre need to be improved because it will have an impact on increasing cadre knowledge [28] According to [16] interventions especially interventions that help improve HIV / AIDS knowledge among students, positively changing students' attitudes towards HIV / AIDS. However, the data from table 3.2 shows that 1 person has less knowledge after being given intervention, this is due to several factors that can influence people's knowledge, such as education level.…”

Understanding mobile application development and implementation to monitor Posyandu data in Indonesia: a 3-year hybrid action research to build “a bridge” from the community to the national scale

“…It differs from the result of another study that employed training intervention to CHWs by using a module in reproductive health and Tuberculosis elds, which demonstrated that there was a large effect. Even though the elds are different, the idea of emphasizing the con dence and satisfaction of CHWs proposed by the study remains essential and relevant (43). In the future, it is suggested to improve the training by emphasizing such insight as well as considering different measures to reach a larger effect in 6 to 12 months (44).…”

“…However, no intervention was given in the research. The interview result showed that the cadres often gathered and created bigger study groups to learn together (43). In further action research, quantitative research can be performed to objectively evaluate video education that is embedded as part of the mobile app.…”

Understanding mobile application development and implementation to monitor Posyandu data in Indonesia: a 3-years hybrid action research to build “a bridge” from the community to national use

“…It differs from the result of another study that employed training intervention to CHWs by using a module in reproductive health and Tuberculosis elds which demonstrated that there was a large effect. Even though the elds are different, the idea of emphasizing the con dence and satisfaction of CHWs proposed by the study remains essential and relevant (42). In future, it is suggested to improve the training by empasizing such insight as well as considering different measures to reach a larger effect in 6 to 12 months (43).…”

“…However, no intervention was given in the research. The interview result showed that the cadres often gathered and created bigger study groups in order to learn together (42). In the further action research, the quantitative research can be performed to objectively evaluate video education that is embedded as part of the mobile app.…”