Novel approaches to measuring knowledge among frontline health workers in India: Are phone surveys a reliable option?

Abstract

Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs' knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for

Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India

“… 25 26 This points to insufficient counselling by FLHWs on infant nutrition and gaps in frontline worker knowledge and capacity. 27 While most qualitative respondents were similarly satisfied with their traditional approaches to family planning, several did acknowledge the fallibility of these methods and almost all wanted to space pregnancies and have just two or three children provided they had at least one son. A single digital direct-to-beneficiary behaviour change communication intervention is very unlikely to change deeply entrenched social and behavioural norms, such as son preference and child feeding behaviours.…”

Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: a feasibility study

“…First, a conceptual framework was developed comprised of factors believed to influence pregnant women's knowledge from previous literature (figure 2). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] At the individual level, characteristics such as phone ownership, healthcare characteristics, socioeconomic and sociodemographic factors were considered. A wealth index was created by dividing the women into five quintiles using principal component analysis.…”

Examining the reach and exposure of a mobile phone-based training programme for frontline health workers (ASHAs) in 13 states across India

“…This cadre of FLHW is the largest of its kind globally, and once deployed ASHAs tend to remain in service for extended periods of time (Findings: cross-sectional surveys among ASHAs in Madhya Pradesh found that 60% of ASHAs had been in service for 4–10 years, 27% for 10+ years and 13% for <4 years. 25 ). Given the volume of providers, and the length of time they remain in-service, low-cost alternatives to in-person training strategies are needed.…”