A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa.
A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa.
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DOI：
10.1186/s12960-017-0210-7
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发表时间：
2017-06-13
影响因子：
4.5
通讯作者：
Rollins N
中科院分区：
文献类型：
--
作者：
Horwood C;Butler L;Barker P;Phakathi S;Haskins L;Grant M;Mntambo N;Rollins N
在世界上许多国家，社区卫生工作者在提供卫生规划方面发挥着关键作用。卫生保健方案可以改善最弱势和偏远社区妇幼保健服务的覆盖面，从而为母亲和儿童带来实质性利益。然而，对卫生工作者有效的指导和监督方法的证据有限。本研究是一项整群随机对照试验，目的是研究持续质素改善（CQI）干预措施在为孕妇及母亲提供家居教育及支援的保健员中的效果。30名CHW监督员被随机分配到干预组（n = 15）和对照组（n = 15）。从每位主管常规支持的chw中随机选择4名chw（每组n = 60）。在干预组，这四名保健员和他们的主管组成质素改善小组。卫生保健工作者接受了为期两周的世卫组织社区病例管理培训，随后接受了为期12个月的社区质量改善指导（在此之前进行了为期3个月的引入，以建立社区质量改善流程）。对居住在参与保健服务的家庭的12个月以下婴儿的母亲进行了基线和随访调查。在基线和随访期间分别对736名和606名母亲进行了访谈；两个研究组和每个时间点的社会人口统计学特征相似。在随访中，与对照组CHW服务的母亲相比，干预CHW服务的母亲在怀孕期间（75.7 vs 29.0%, p < 0.0001）和产后（72.6 vs 30.3%, p < 0.0001）更有可能接受CHW访问。干预组母亲的妇幼保健知识得分较高（49比43%，p = 0.02）， 6周纯母乳喂养率较高（76.7比65.1%,p = 0.02）。接受干预保健员服务的艾滋病毒阳性母亲更有可能向保健员透露自己的艾滋病毒状况（78.7比50.0%,p = 0.007）。采用以设施为基础的干预措施没有显著差异。改进对卫生工作者的培训和基于cqi的指导可以提高家庭一级卫生工作者与母亲互动的数量和质量，从而改善母亲的知识和婴儿喂养做法。临床试验。Gov NCT01774136
Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs. This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Four CHWs were randomly selected from those routinely supported by each supervisor (n = 60 per arm). In the intervention arm, these four CHWs and their supervisor formed a quality improvement team. Intervention CHWs received a 2-week training in WHO Community Case Management followed by CQI mentoring for 12 months (preceded by 3 months lead-in to establish QI processes). Baseline and follow-up surveys were conducted with mothers of infants <12 months old living in households served by participating CHWs. Interviews were conducted with 736 and 606 mothers at baseline and follow-up respectively; socio-demographic characteristics were similar in both study arms and at each time point. At follow-up, compared to mothers served by control CHWs, mothers served by intervention CHWs were more likely to have received a CHW visit during pregnancy (75.7 vs 29.0%, p < 0.0001) and the postnatal period (72.6 vs 30.3%, p < 0.0001). Intervention mothers had higher maternal and child health knowledge scores (49 vs 43%, p = 0.02) and reported higher exclusive breastfeeding rates to 6 weeks (76.7 vs 65.1%, p = 0.02). HIV-positive mothers served by intervention CHWs were more likely to have disclosed their HIV status to the CHW (78.7 vs 50.0%, p = 0.007). Uptake of facility-based interventions were not significantly different. Improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers’ knowledge and infant feeding practices. ClinicalTrials.Gov NCT01774136