0
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evaluation of the Impact of Immunization Second Year of Life Training Interventions on Health Care Workers in Ghana

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Applying performance-based training interventions that follow adult learning principles and include follow-up activities after training may help to solve specific performance problems and improve health care workers’ performance in immunization service delivery. These strategies facilitate learning, minimize the forgetting curve for health care workers, and should be considered as a standard practice for future training interventions.

          Abstract

          Key Findings

          • After implementing the immunization Second Year of Life capacity-building interventions, quantitative and qualitative data showed that health care workers (HCWs) reported a modest improvement in knowledge, attitudes, and practices in 3 performance problem areas: lack of knowledge on EPI policy; inconsistent data management, quality, and use; and weak communication about vaccination with caregivers.

          • Trainers in district health management teams used a variety of teaching methods and delivery techniques to facilitate HCWs’ learning and help minimize their forgetting curve.

          Key Implications

          • National and subnational leaders should take ownership of the capacity-building needs of their immunization workers and leverage existing mechanisms, such as new hire orientation, supportive supervision visits, and monthly data review meetings to empower their health care workers to perform EPI tasks more proficiently.

          • Countries should value budgeting for capacity building of their immunization workforce and for behavior change evaluation to ensure an accurate understanding of capacity-building impact.

          • Stakeholders should define their expectations of specific tangible outputs from training that link to a measurable performance objective, instead of broad “refresher” training.

          ABSTRACT

          Introduction:

          As part of a suite of training interventions to improve the knowledge and practice of immunization in the second year of life (2YL), training of trainers workshops were conducted with regional and district health management teams (DHMTs) in 15 districts in 3 regions of Ghana. Using adult learning principles, DHMTs implemented several capacity-building activities at the subdistrict and health facility levels, including health facility visits, on-the-job training, and review meetings. The current evaluation investigated whether frontline health care workers (HCWs) reported or demonstrated improvements in knowledge, attitudes, and practices after training interventions.

          Methods:

          Quantitative and qualitative methods with a utilization-focused approach guided the framework for this evaluation. A systematic random sample of 115 HCWs in 3 regions of Ghana was selected to complete a competency survey before and after training, which focused on 3 core competency areas—Expanded Programme on Immunization (EPI) policy; communication with caregivers; and immunization data management, recording, and use. Interviews and direct observations by data collectors were done to assess HCWs’ knowledge, self-reported attitude, and behavior changes in practices.

          Results:

          Of 115 HCWs, 102 were surveyed before and 4 months after receiving capacity-building interventions. Modest but not statistically significant improvements were found in knowledge on EPI policy, immunization data management, and communication skills with caregivers. HCWs reported that they had improved several attitudes and practices after the 2YL training. The most improved practice reported by HCWs and observed in all 3 regions was the creation of a defaulter list.

          Discussion:

          Findings of this evaluation provide encouraging evidence in taking the first step toward improving HCW knowledge, attitudes, and practices for 3 core immunization competency areas. The use of learner-focused teaching methods combined with adult learning principles is helpful in solving specific performance problems (such as lack of knowledge of EPI policy).

          Related collections

          Most cited references 18

          • Record: found
          • Abstract: not found
          • Article: not found

          Redefine statistical significance

            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review

            Summary Background Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs. Methods For this systematic review we searched 52 electronic databases for published studies and 58 document inventories for unpublished studies from the 1960s to 2016. Eligible study designs were controlled trials and interrupted time series. We only included strategy-versus-control group comparisons. We present results of improving health-care provider practice outcomes expressed as percentages (eg, percentage of patients treated correctly) or as continuous measures (eg, number of medicines prescribed per patient). Effect sizes were calculated as absolute percentage-point changes. The summary measure for each comparison was the median effect size (MES) for all primary outcomes. Strategy effectiveness was described with weighted medians of MES. This study is registered with PROSPERO, number CRD42016046154. Findings We screened 216 477 citations and selected 670 reports from 337 studies of 118 strategies. Most strategies had multiple intervention components. For professional health-care providers (generally, facility-based health workers), the effects were near zero for only implementing a technology-based strategy (median MES 1·0 percentage points, IQR −2·8 to 9·9) or only providing printed information for health-care providers (1·4 percentage points, −4·8 to 6·2). For percentage outcomes, training or supervision alone typically had moderate effects (10·3–15·9 percentage points), whereas combining training and supervision had somewhat larger effects than use of either strategy alone (18·0–18·8 percentage points). Group problem solving alone showed large improvements in percentage outcomes (28·0–37·5 percentage points), but, when the strategy definition was broadened to include group problem solving alone or other strategy components, moderate effects were more typical (12·1 percentage points). Several multifaceted strategies had large effects, but multifaceted strategies were not always more effective than simpler ones. For lay health-care providers (generally, community health workers), the effect of training alone was small (2·4 percentage points). Strategies with larger effect sizes included community support plus health-care provider training (8·2–125·0 percentage points). Contextual and methodological heterogeneity made comparisons difficult, and most strategies had low quality evidence. Interpretation The impact of strategies to improve health-care provider practices varied substantially, although some approaches were more consistently effective than others. The breadth of the HCPPR makes its results valuable to decision makers for informing the selection of strategies to improve health-care provider practices in LMICs. These results also emphasise the need for researchers to use better methods to study the effectiveness of interventions. Funding Bill & Melinda Gates Foundation, CDC Foundation.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found
              Is Open Access

              Abandon Statistical Significance

                Bookmark

                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health: Science and Practice
                Global Health: Science and Practice
                2169-575X
                30 September 2021
                30 September 2021
                : 9
                : 3
                : 498-507
                Affiliations
                [a ]Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention , Atlanta, GA, USA.
                [b ]African Field Epidemiology Network , Accra, Ghana.
                [c ]Ghana Health Service, Public Health Division, Disease Control and Prevention Department, Expanded Programme on Immunization , Korle Bu, Accra, Ghana.
                Author notes
                Correspondence to Dieula Delissaint Tchoualeu ( Dtchoualeu@ 123456cdc.gov ).
                Article
                GHSP-D-21-00091
                10.9745/GHSP-D-21-00091
                8514031
                34593577
                e64c6cbc-6159-4c8a-81f6-f772b2955fb2
                © Tchoualeu et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00091

                Product
                Categories
                Original Article

                Comments

                Comment on this article