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Formative evaluation of a training intervention for community health workers in South Africa : a before and after study
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Plowright, Alexandra S., Taylor, Celia A., Davies, David, Sartori, Jo, Lewando-Hundt, Gillian and Lilford, Richard (2018) Formative evaluation of a training intervention for community health workers in South Africa : a before and after study. PLoS One, 13 (9). e0202817. doi:10.1371/journal.pone.0202817 ISSN 1932-6203.
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WRAP-formative-evaluation-training-intervention-community-health-workers-South-Africa-Lilford-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (996Kb) | Preview |
Official URL: http://dx.doi.org/10.1371/journal.pone.0202817
Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Community health aides -- Training of -- South Africa, AIDS (Disease), Sexually transmitted diseases, Tuberculosis, Women's health services | ||||||
| Journal or Publication Title: | PLoS One | ||||||
| Publisher: | Public Library of Science | ||||||
| ISSN: | 1932-6203 | ||||||
| Official Date: | 24 September 2018 | ||||||
| Dates: |
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| Volume: | 13 | ||||||
| Number: | 9 | ||||||
| Page Range: | e0202817 | ||||||
| DOI: | 10.1371/journal.pone.0202817 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 25 September 2018 | ||||||
| Date of first compliant Open Access: | 25 September 2018 | ||||||
| RIOXX Funder/Project Grant: |
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