RT Journal Article
SR Electronic
T1 Methods and Measures to Assess Health Care Provider Behavior and Behavioral Determinants in Reproductive, Maternal, Newborn, and Child Health: A Rapid Review
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 e2200407
DO 10.9745/GHSP-D-22-00407
VO 11
IS Supplement 1
A1 Dougherty, Leanne
A1 Mathur, Sanyukta
A1 Gul, Xaher
A1 Spielman, Kathryn
A1 Tripathi, Vandana
A1 Wakefield, Christina
A1 Silva, Martha
YR 2023
UL http://www.ghspjournal.org/content/11/Supplement_1/e2200407.abstract
AB Key FindingsThis rapid review identified opportunities and gaps in measurement of health care provider behavior by focusing on domains that correspond to factors that influence provider behavior and service provision and incorporate elements beyond provider competency and skills.Of the studies included in this review, 65% focused on providers' ability (knowledge, skills, and access to clinical training); 70% focused on predisposing factors (attitudes, beliefs, and perceptions); 57% focused on enabling factors (resources and skills required to make behavioral changes); and 36% focused on reinforcing factors (e.g., peer support and supervisor feedback).Most studies did not test associations between behavioral determinants and provider behaviors.Key ImplicationsProgram implementers, donors, and researchers should support the evaluation of provider behavior change programs to shift the evidence base from one that is focused on describing behaviors to one that uses theory-driven approaches to understand behavioral antecedents and impacts of behavior change interventions on provider behaviors and their drivers.Evaluators should develop and apply validated measures of provider behavior to enable comparable learning and support policymakers to target quality improvement and invest in evidence-based behavior change programs.Background:Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming.Methods:Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in low- and middle-income countries (2010–2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter's PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized.Results:More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, training-focused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors.Conclusion:A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider's behavior (beyond knowledge-enhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.