Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa.
Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa.
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DOI：
10.3389/fpubh.2022.868252
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发表时间：
2022
影响因子：
5.2
通讯作者：
Griffiths, Frances
中科院分区：
文献类型：
--
作者：
Babalola, Olukemi;Goudge, Jane;Levin, Jonathan;Brown, Celia;Griffiths, Frances
关键词：
对提供综合护理的社区卫生工作者的护理质量评估工具的研究很少，而且现有的评估工具的实用性证据也很少。我们的目的是评估效用组件的先前报告的护理质量评估工具，在南非的总结性评估。在两个省，我们使用了每个省两个初级卫生保健机构的21名CHW和3名团队负责人的评分，评价该工具是否涵盖了他们家庭访问期间发生的一切，以及他们是否愿意使用该工具进行评估（可接受性和表面效度），以得出一致性指数（≥ 85%，否则必须修改该工具）。一个由六名专家组成的小组对该工具的11个项目进行了定量验证（内容有效性）。内容效度指数（CVI），个别项目（I-CVI）或整个量表（S-CVI），应>80%（优秀）。对于评分者间可靠性（IRR），我们确定了配对观察员在18个CHW家庭访问（每个站点9个家庭）期间分配的护理质量信息和沟通评分之间的一致性。Bland和Altman图和多水平模型分析，用于聚类数据，以评估IRR。在所有四个CHW和团队负责人研究中心中，一致性指数≥ 85%，除了他们是否愿意使用该工具进行评估，其中一个机构的一致性指数<85%。工具中11个项目的I-CVI范围在0.83和1.00之间。对于S-CVI，所有六位专家都同意11个项目中的8个项目（0.72）的相关性（普遍一致），而I-CVI的平均值为0.95。配对观察者之间的Bland-Altman图一致性界限分别为-0.18至0.44和-0.30至0.44（消息评分）;-0.22至0.45和-0.28至0.40（沟通评分）。多层次模型显示，估计的可靠性为0.77（消息得分）和0.14（通信得分）。护理质量评估工具具有较高的表面效度和内容效度。IRR是实质性的护理质量的消息，但不是沟通得分。这表明，该工具可能只在CHW的形成性评估中有用。这样的评估可以为反思和讨论CHW的表现提供基础，并导致改变。
Few studies exist on the tools for assessing quality-of-care of community health worker (CHW) who provide comprehensive care, and for available tools, evidence on the utility is scanty. We aimed to assess the utility components of a previously-reported quality-of-care assessment tool developed for summative assessment in South Africa. In two provinces, we used ratings by 21 CHWs and three team leaders in two primary health care facilities per province regarding whether the tool covered everything that happens during their household visits and whether they were happy to be assessed using the tool (acceptability and face validity), to derive agreement index (≥85%, otherwise the tool had to be revised). A panel of six experts quantitatively validated 11 items of the tool (content validity). Content validity index (CVI), of individual items (I-CVI) or entire scale (S-CVI), should be >80% (excellent). For the inter-rater reliability (IRR), we determined agreement between paired observers' assigned quality-of-care messages and communication scores during 18 CHW household visits (nine households per site). Bland and Altman plots and multilevel model analysis, for clustered data, were used to assess IRR. In all four CHW and team leader sites, agreement index was ≥85%, except for whether they were happy to be assessed using the tool, where it was <85% in one facility. The I-CVI of the 11 items in the tool ranged between 0.83 and 1.00. For the S-CVI, all six experts agreed on relevancy (universal agreement) in eight of 11 items (0.72) whereas the average of I-CVIs, was 0.95. The Bland-Altman plot limit of agreements between paired observes were −0.18 to 0.44 and −0.30 to 0.44 (messages score); and −0.22 to 0.45 and −0.28 to 0.40 (communication score). Multilevel modeling revealed an estimated reliability of 0.77 (messages score) and 0.14 (communication score). The quality-of-care assessment tool has a high face and content validity. IRR was substantial for quality-of-care messages but not for communication score. This suggests that the tool may only be useful in the formative assessment of CHWs. Such assessment can provide the basis for reflection and discussion on CHW performance and lead to change.
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