期刊
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
卷 18, 期 15, 页码 -出版社
MDPI
DOI: 10.3390/ijerph18157891
关键词
community health workers; integrated intervention; group sessions; early child development; maternal mental health; prevention of lead exposure; Bangladesh
资金
- Bill and Melinda Gates Foundation [OPP1146808]
- Bill and Melinda Gates Foundation [OPP1146808] Funding Source: Bill and Melinda Gates Foundation
Community Health Workers in rural Bangladesh successfully implemented an intervention integrating various components for maternal and child health. Challenges included the complexity of behavioral recommendations and distractions during group sessions, but strategies were identified to strengthen intervention-delivery and allow for scale-up. Iterative revisions based on qualitative evaluation findings could facilitate feasible delivery by CHWs.
Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs' training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children's attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.
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