Centre for Global Health, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland.
School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
Ann Glob Health. 2016 Sep-Oct;82(5):936-949. doi: 10.1016/j.aogh.2016.07.002.
The unprecedented access to mobile phones in resource-poor settings has seen the emergence of mobile-health (mHealth) applications specific for low- and middle-income contexts. One such application is the Mobile Technology for Community Health Suite (MOTECH Suite). Given the importance of community health worker (CHW) perceptions of a health program toward its successful implementation, this study explores whether the introduction of an mHealth application, as a human resource management tool, is associated with changes in CHW perceived supervision, motivation, work engagement, and job satisfaction over time.
We employed a 3-arm randomized longitudinal cohort design in Bonthe District, Sierra Leone. Three hundred twenty-seven CHWs were assessed over an 18-month period, with 3 different rounds of data collection. CHWs were assigned to 3 different intervention groups and given either a mobile phone with access to both the application and to a closed user group; a phone set up on a closed user group but with no application; or no mobile phone but the same level of training as the previous 2 groups.
Findings indicated that there were no initial or sustained differences in perceived supervision and motivation across the 3 experimental groups over time with the introduction of the MOTECH Suite as a human resource management tool. Furthermore, there was no significant change in the self-reported measures of work engagement and job satisfaction across each of the intervention groups over time.
DISCUSSION/CONCLUSION: Findings suggest that there are no systematic changes in perceived supervision, work engagement, job satisfaction, or motivation between CHWs who received a mobile phone set up on a closed user group with the MOTECH Suite application and those who either only received a phone with the closed user group or no phone at all. Therefore, the results of this study do not provide sufficient evidence to support the use of mobile technology or mHealth applications to strengthen these organizational factors within CHW programs and interventions. We argue that strengthening the organizational factors within CHW programs must therefore extend beyond the introduction of a technological solution.
在资源匮乏的环境中，移动电话的普及程度前所未有，因此出现了针对中低收入国家和地区的移动医疗（mHealth）应用。其中一个应用是移动技术社区卫生套件（MOTECH Suite）。鉴于社区卫生工作者（CHW）对健康计划的看法对其成功实施的重要性，本研究探讨了作为人力资源管理工具的 mHealth 应用程序的引入是否会随着时间的推移而改变 CHW 感知的监督、激励、工作投入和工作满意度。
我们在塞拉利昂邦特区采用了 3 臂随机纵向队列设计。327 名 CHW 在 18 个月的时间内进行了评估，共进行了 3 轮数据收集。CHW 被分配到 3 个不同的干预组，并分别获得一部可访问应用程序和封闭用户组的手机；一部设置在封闭用户组但没有应用程序的手机；或没有手机但与前两组接受相同水平的培训。
研究结果表明，在引入 MOTECH Suite 作为人力资源管理工具后，随着时间的推移，3 个实验组在感知监督和激励方面没有初始或持续的差异。此外，在每个干预组中，工作投入和工作满意度的自我报告衡量指标在整个研究期间都没有显著变化。
讨论/结论：研究结果表明，在接受设置有 MOTECH Suite 应用程序的封闭用户组手机的 CHW 与仅接受带封闭用户组手机或根本没有手机的 CHW 之间，在感知监督、工作投入、工作满意度或激励方面没有系统的变化。因此，本研究的结果并没有提供足够的证据支持使用移动技术或 mHealth 应用程序来加强 CHW 计划和干预措施中的这些组织因素。我们认为，加强 CHW 计划中的组织因素必须超越引入技术解决方案。
