Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda.
Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda.
复制标题
利用理论和形成性研究来设计干预措施，以改善莫桑比克和乌干达的社区卫生工作者动机，保留和表现。
DOI：
10.1186/s12960-015-0020-8
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发表时间：
2015-04-30
影响因子：
4.5
通讯作者：
inSCALE study group
中科院分区：
文献类型：
--
作者：
Strachan DL;Källander K;Nakirunda M;Ndima S;Muiambo A;Hill Z;inSCALE study group
低收入国家越来越多地使用社区卫生工作者(CHW)来解决人力资源短缺问题，但仍然没有多少有效的、以证据为基础的战略来解决长期存在的对工作人员积极性、保留率和绩效的方案制约。本文介绍了社区获取和持久影响创新(INSCALE)项目如何利用行为学理论和形成性研究成果，在乌干达和莫桑比克设计了两项干预措施，以解决这些制约因素。对工作动机和CHW动机的文献进行了综述--结合了对保持和表现的影响--对来自电子网络搜索的文章进行了分析。在乌干达和莫桑比克，与社区卫生工作者和主要利益攸关方一起进行了形成性研究，重点是CHW动机、留住和绩效的障碍和促进者。对全国各地98次深度访谈和26次重点小组讨论的记录进行了专题分析，采用了分析性归纳方法。从理论审查中确定，干预措施应通过突出分享经验的意识、注重工作人员与方案目标之间的一致性以及强调导致良好业绩的行动来促进社区卫生工作者成为集体的成员。社会认同方法被选为最有可能导致开发有效、可扩展和可持续干预措施的理论，因为它解决了在有关CHW工作环境的影响的文献中发现的空白。形成性研究表明，社区卫生工作者重视与卫生系统及其社区相关的反馈和感受，受到地位和社区地位的激励，并希望获得必要的工具来执行任务。根据这些结果制定了两项干预措施：参与性的当地社区办法和信息通信技术办法。利用对背景敏感的背景数据和理论，有可能导致制定适当和有效的干预措施，以改善乌干达、莫桑比克和其他类似环境中的社区卫生工作者的动机、保留和业绩。评估已制定的干预措施对于评估这一潜力至关重要。
Community health workers (CHWs) are increasingly being used in low-income countries to address human resources shortages, yet there remain few effective, evidence-based strategies for addressing the enduring programmatic constraints of worker motivation, retention and performance. This paper describes how two interventions were designed by the Innovations at Scale for Community Access and Lasting Effects (inSCALE) project to address these constraints in Uganda and Mozambique drawing on behavioural theory and formative research results. A review of the work motivation and CHW motivation literature—incorporating influences on retention and performance—was conducted on articles sourced through electronic web searches. Formative research with a focus on the barriers and facilitators to CHW motivation, retention and performance was conducted with community health workers and key stakeholders in Uganda and Mozambique. An analytical induction approach to the thematic analysis of transcripts from 98 in-depth interviews and 26 focus group discussions was adopted across the country settings. From the theoretical review, it was determined that the interventions should promote CHWs as members of a collective by highlighting a sense of shared experience, focus on alignment between worker and programme goals, and emphasise the actions that lead to good performance. The Social Identity Approach was selected as the theory most likely to lead to the development of effective, scalable and sustainable interventions by addressing the identified gap in the literature of the influence of CHW working context. The formative research indicated that CHWs value feedback and feeling connected to the health system and their community, are motivated by status and community standing, and want to be provided with the necessary tools to perform. Two interventions based on these results were developed: a participatory, local community approach and an information communication technology (ICT) approach. Drawing on contextual data and theory that is sensitive to context can potentially lead to the development of appropriate and effective interventions when aiming to improve the motivation, retention and performance of CHWs in Uganda and Mozambique and other comparable settings. Evaluation of the developed interventions is crucial to assess this potential.