Limato Ralalicia, Ahmed Rukhsana, Magdalena Amelia, Nasir Sudirman, Kotvojs Fiona
Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430, Indonesia.
Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430, Indonesia; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK.
Eval Program Plann. 2018 Feb;66:102-110. doi: 10.1016/j.evalprogplan.2017.10.011. Epub 2017 Oct 19.
Maternal health promotion is a defined activity in the community integrated posts (Posyandu) in Indonesia. However, it is often neglected due to limited knowledge and skills of the community health workers (kader). We conducted health promotion training for the kader and village midwives in four villages in Cianjur district. This study describes the use of "most significant change" (MSC) technique to evaluate impact of health promotion to the beneficiaries and community at large. The MSC uses stories as raw data. Through interviews focused on perception of change, stories were collected from four pregnant women, eight kader and three village midwives. A Panel consisting of policy and programme managers and implementers read all the stories. The story by a pregnant woman who routinely attended Posyandu was selected as the story with most significant change. Her story highlighted changes in kader's knowledge and communication of health messages and attitude towards pregnant women. She expressed these changes impacted community awareness about health and to seek help from kader.The MSC technique enabled stakeholders to view raw data and evaluate the impact of health promotion from the beneficiary's perspective. At the same time, recipients of health promotion contributed to the decision process of evaluation through their stories. The different perspectives on the MSC reflected individual's objectives of the health promotion. The application of this technique is limited in maternal health promotion programme in Indonesia, and none have been published in peer reviewed journals.
孕产妇健康促进是印度尼西亚社区综合卫生站（Posyandu）开展的一项既定活动。然而，由于社区卫生工作者（kader）知识和技能有限，这项活动常常被忽视。我们在西爪哇省芝安朱尔县的四个村庄为社区卫生工作者和乡村助产士开展了健康促进培训。本研究描述了使用“最显著变化”（MSC）技术来评估健康促进对受益者及整个社区的影响。MSC技术将故事作为原始数据。通过聚焦于变化认知的访谈，从四名孕妇、八名社区卫生工作者和三名乡村助产士那里收集了故事。一个由政策和项目管理人员及实施者组成的小组阅读了所有故事。一名经常参加卫生站活动的孕妇所讲述的故事被选为最显著变化的故事。她的故事突出了社区卫生工作者在健康信息知识、沟通以及对孕妇态度方面的变化。她表示这些变化影响了社区对健康的认识以及向社区卫生工作者寻求帮助的行为。MSC技术使利益相关者能够查看原始数据，并从受益者的角度评估健康促进的影响。与此同时，健康促进的接受者通过他们的故事为评估的决策过程做出了贡献。对MSC的不同观点反映了个人对健康促进的目标。这项技术在印度尼西亚孕产妇健康促进项目中的应用有限，且尚无在同行评审期刊上发表的相关内容。
