Title
A cluster-randomized trial to test sharing histories as a training method for community health workers in Peru
Date Issued
01 December 2020
Access level
open access
Resource Type
journal article
Author(s)
Publisher(s)
Johns Hopkins University Press
Abstract
Background: Community health workers (CHWs) are increasingly deployed to support mothers' adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning. Methods: We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0-23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-forage (HAZ)<-2 Z-scores (stunting) in children aged 0-23 months. Household surveys were conducted at baseline (606 cases) and 4-year follow-up (606 cases). Results: Maternal and child characteristics were similar in both study arms at baseline and follow-up. Difference-in-differences analysis showed mean HAZ changes were not significantly different in experimental versus control clusters from baseline to endline (P=.469). However, in the subgroup of literate mothers, mean HAZ improved by 1.03 on the Z-score scale in experimental clusters compared to control clusters from baseline to endline (P=.059). Using generalized estimating equations, we demonstrated that stunting in children of mothers who were literate was significantly reduced (Beta=0.77; 95% confidence interval=0.23, 1.31; P<.01), adjusting for covariates. Conclusion: Compared with standard training methods, SH may have improved the effectiveness of CHWs as change agents among literate mothers to reduce child stunting. Stunting experienced by the children of illiterate mothers may have involved unaddressed determinants of stunting.
Start page
732
End page
758
Volume
8
Issue
4
Language
English
OCDE Knowledge area
Temas sociales
Salud ocupacional
Scopus EID
2-s2.0-85099074321
PubMed ID
Source
Global Health Science and Practice
Sponsor(s)
This field project with embedded cluster randomized controlled trial research was made possible by a competitive grant to Future Generations from the United States Agency for International Development - Office of Global Health (Child Survival and Health Grants Program, Cooperative Agreement No. AID-OAA-10-00048) for the project Health in the Hands of Women: A Test of Teaching Methods in addition to support from the Carl E. Taylor Endowment for Equity and Empowerment, Future Generations University, and local government partners in Peru. The Maternal Health Task Force of EngenderHealth through a subgrant from the Bill and Melinda Gates Foundation (GMH-107-1) provided support to an earlier project in indigenous Andean villages of Cusco to adapt the sharing histories method to Peru. The views expressed in this article are the authors' and are not an official position of the funder.
Funding: This field project with embedded cluster randomized controlled trial research was made possible by a competitive grant to Future Generations from the United States Agency for International Development – Office of Global Health (Child Survival and Health Grants Program, Cooperative Agreement No. AID-OAA-10-00048) for the project Health in the Hands of Women: A Test of Teaching Methods in addition to support from the Carl E. Taylor Endowment for Equity and Empowerment, Future Generations University, and local government partners in Peru. The Maternal Health Task Force of EngenderHealth through a subgrant from the Bill and Melinda Gates Foundation (GMH-107-1) provided support to an earlier project in indigenous Andean villages of Cusco to adapt the sharing histories method to Peru. The views expressed in this article are the authors’ and are not an official position of the funder.
Sources of information:
Directorio de Producción Científica
Scopus