Formative evaluation of a training intervention for community health workers in South Africa: A before and after study.
Formative evaluation of a training intervention for community health workers in South Africa: A before and after study.
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DOI：
10.1371/journal.pone.0202817
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Lilford RJ
中科院分区：
文献类型：
--
作者：
Plowright A;Taylor C;Davies D;Sartori J;Hundt GL;Lilford RJ
社区卫生工作者(社区卫生工作者)在改善社区健康方面发挥着至关重要的作用，他们的作用在世界许多地区正在扩大。然而，社区卫生服务的有效性受到培训不足的限制，社区卫生服务的教育也几乎没有受到科学的重视。我们的研究是在南非夸祖鲁-纳塔尔的两个地区进行的。我们制定并试行了一项低成本(两天)的培训干预措施，涵盖国家政府的优先事项：艾滋病毒/艾滋病、性传播疾病和结核病；以及妇女的性健康和生殖健康与权利。64名CHW同意参加这项主要研究，该研究使用四种不同测试程序的改进所罗门设计来衡量知识获取，以区分干预、测试以及干预和测试之间的任何交互作用的效果。我们还衡量了信心、满意度和成本。在培训干预之后，在不同主题和不同地区的知识得分都有所提高。这些知识方面的变化具有统计学意义(p<；0.001)，而且幅度很大(超过45个百分点或4个标准差)。然而，在一个地区分配到测试-测试-列车时间表的社区卫生工作者在接受培训之前显示出知识的高度增长。所有CHW对培训的满意度都很高，他们对向客户提供建议的信心也有了明显的改善。培训费用约为每名CHW每天48美元，如果知识的大幅增长转化为实地业绩的改善，从而产生健康结果，则培训具有潜在的成本效益。通过短期干预，培训社区卫生工作者可以大大提高知识水平。然而，在其他研究中看到的改善可能是由于测试的“反应性”。还需要进一步的工作来衡量我们的结果的普适性、知识的保留率以及改进的知识转化为改进的实践的程度。
Community 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. Our 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. Following 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. Training 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.
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影响因子：
3.2
作者：
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通讯作者：
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作者：
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影响因子：
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