RT Journal Article
SR Electronic
T1 Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 358
OP 371
DO 10.9745/GHSP-D-20-00027
VO 8
IS 3
A1 Peter Smittenaar
A1 B.M. Ramesh
A1 Mokshada Jain
A1 James Blanchard
A1 Hannah Kemp
A1 Elisabeth Engl
A1 Shajy Isac
A1 John Anthony
A1 Ravi Prakash
A1 Vikas Gothalwal
A1 Vasanthakumar Namasivayam
A1 Pankaj Kumar
A1 Sema K. Sgaier
YR 2020
UL http://www.ghspjournal.org/content/8/3/358.abstract
AB Key FindingsCommunity health worker (CHW) presence, number and timing of visits, behavior change messaging strategies, and focus on specific household members for different behaviors associates with maternal and newborn care practices.Local sociocultural factors such as the decision dynamics of households and common false beliefs about neonatal care should inform how the CHW communicates.Key ImplicationsProgram managers can use these insights to adapt the CHW training, incentives, and tools to achieve greater impact.Other CHW programs can use this approach to identify opportunities to improve the effectiveness of their workers in terms of communication, knowledge, and number and timing of visits. Introduction:Community health workers (CHWs) play a key role in the health of mothers and newborns in low- and middle-income countries. However, it remains unclear by what actions and messages CHWs enable good outcomes and respectful care.Methods:We collected a uniquely linked set of questions on behaviors, beliefs, and care pathways from recently delivered women (n=5,469), their husbands (n=3,064), mothers-in-law (n=3,626), and CHWs (accredited social health activists; n=1,052) in Uttar Pradesh, India. We used logistic regression to study associations between CHW actions and household behaviors during antenatal, delivery, and postnatal periods.Results:Pregnant women who were visited earlier in pregnancy and who received multiple visits were more likely to perform recommended health behaviors including attending multiple checkups, consuming iron and folic acid tablets, and delivering in a health facility (ID), compared to women visited later or receiving fewer visits, respectively. Counseling the woman was associated with higher likelihood of attending 3+ checkups and consuming 100+ iron and folic acid tablets, whereas counseling the husband and mother-in-law was associated with higher rates of ID. Certain behavior change messages, such as the danger of complications, were associated with more checkups and ID, but were only used by 50%–80% of CHWs. During delivery, 57% of women had the CHW present, and their presence was associated with respectful care, early initiation of breastfeeding, and exclusive breastfeeding, but not with delayed bathing or clean cord care. The newborn was less likely to receive delayed bathing if the CHW incorrectly believed that newborns could be bathed soon after birth (which is believed by 30% of CHWs). CHW presence was associated with health behaviors more strongly for home than facility deliveries. Home visits after delivery were associated with higher rates of clean cord care and exclusive breastfeeding. Counseling the mother-in-law (but not the husband or woman) was associated with exclusive breastfeeding.Conclusion:We identified potential ways in which CHW impact could be improved, specifically by emphasizing the importance of home visits, which household members are targeted during these visits, and what messages are shared. Achieving this change will require training CHWs in counseling and behavior change and providing supervision and modern tools such as apps that can help the CHW keep track of her beneficiaries, suggest behavior change strategies, and direct attention to households that stand to gain the most from support.