Sato Yu, Pongvongsa Tiengkham, Nonaka Daisuke, Kounnavong Sengchanh, Nansounthavong Phetsomphone, Moji Kazuhiko, Phongmany Panom, Kamiya Yasuhiko, Sato Miho, Kobayashi Jun
Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan.
BMC Health Serv Res. 2014 Mar 12;14:123. doi: 10.1186/1472-6963-14-123.
Improving the performance of community health workers (CHWs) is a global issue. The relationship between CHWs and their community may impact their performance. In Lao People's Democratic Republic (Lao PDR), CHW are called village health volunteers (VHV). Lao PDR has a problem with VHV inactivity, especially in rural areas. This study focused on which aspects of social capital are related to VHV performance.
This research represents a cross-sectional study with a quantitative survey based primarily on interviews using a semi-structured questionnaire. Interviews were conducted with 149 VHVs living and working in the Sepon District. VHV performance evaluation was measured with scores on a 5-point scale, and the cutoff point for designating performance as good or poor was set at the median score. This evaluation of VHV performance was conducted as a self-evaluation by VHVs and by health center staff who were supervisors of the VHVs. Measurement of social capital was accomplished using the short version of the Adapted Social Capital Assessment Tool (SASCAT). For statistical analyses, logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).
The results of multiple logistic regression adjusted by moderator variables showed that citizenship activities in the structural social capital component of SASCAT were significantly related to performance in self-evaluation by VHVs (adjusted OR: 2.10, 95% CI: 1.19-3.71) and the evaluations by health center staff (adjusted OR: 1.67, 95% CI: 1.01-2.77). Support from groups (adjusted OR: 1.87, 95% CI: 1.27-2.76) and cognitive social capital (adjusted OR: 7.48, 95% CI: 2.14-26.10) were found to be significantly associated but only for VHV self-evaluation.
The results suggest that individuals who interact with important figures in the community and who cooperate with other villagers whenever problems arise, i.e., have social capital, exhibit good performance as VHVs. These findings suggest that increasing citizenship activities could increase the retention rate of CHWs and help improve their performance. Citizenship activities could also be used as a predictive indicator when selecting new CHWs.
提高社区卫生工作者（CHW）的工作绩效是一个全球性问题。CHW与其所在社区之间的关系可能会影响他们的工作绩效。在老挝人民民主共和国（老挝），CHW被称为乡村卫生志愿者（VHV）。老挝存在VHV不活跃的问题，尤其是在农村地区。本研究聚焦于社会资本的哪些方面与VHV的工作绩效相关。
本研究为横断面研究，主要通过使用半结构化问卷进行访谈的定量调查。对居住和工作在色邦区的149名VHV进行了访谈。VHV工作绩效评估采用5分制评分，将绩效评定为良好或不佳的临界点设定为中位数分数。VHV工作绩效的评估由VHV进行自我评估以及由作为VHV上级的卫生中心工作人员进行评估。社会资本的测量使用了简化版的适应性社会资本评估工具（SASCAT）。对于统计分析，采用逻辑回归计算调整后的比值比（OR）和95%置信区间（CI）。
经调节变量调整后的多重逻辑回归结果显示，SASCAT结构社会资本组成部分中的公民活动与VHV自我评估的绩效（调整后的OR：2.10，95% CI：1.19 - 3.71）以及卫生中心工作人员的评估（调整后的OR：1.67，95% CI：1.01 - 2.77）显著相关。群体支持（调整后的OR：1.87，95% CI：1.27 - 2.76）和认知社会资本（调整后的OR：7.48，95% CI：2.14 - 26.10）被发现显著相关，但仅针对VHV自我评估。
结果表明，那些与社区中有重要影响力的人物互动且在出现问题时与其他村民合作的个体，即拥有社会资本的个体，作为VHV表现良好。这些发现表明，增加公民活动可以提高CHW的留存率并有助于改善他们的绩效。公民活动也可在选拔新的CHW时用作预测指标。
