社区卫生工作者干预对公众满意度的影响：来自坦桑尼亚达累斯萨拉姆一项未注册结局的整群随机对照试验的证据。

The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania.

机构信息

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA, 02115, United States of America.

Management and Development for Health, Dar es Salaam, Tanzania.

出版信息

Hum Resour Health. 2019 Mar 29;17(1):23. doi: 10.1186/s12960-019-0355-7.

DOI:10.1186/s12960-019-0355-7

PMID:30922341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6440091/

Abstract

BACKGROUND

There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered.

METHODS

From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women's satisfaction with the CHW program and with the public-sector health system in Dar es Salaam.

RESULTS

In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27).

CONCLUSIONS

A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov, EJF22802.

摘要

背景

关于不同医疗服务提供方式对卫生系统满意度的因果效应，相关证据十分匮乏。在向社区卫生工作者（CHW）转移任务的背景下，深入了解公众对卫生系统的满意度尤为重要。本文旨在确定以孕产妇保健服务为重点的 CHW 项目对坦桑尼亚达累斯萨拉姆市处于孕期或产后不久的妇女对卫生系统满意度的影响。

方法

2013 年 1 月至 2014 年 4 月，我们开展了一项 CHW 项目的卫生系统实施试验，采用整群随机对照设计。坦桑尼亚达累斯萨拉姆市的 60 个区被随机分配到孕产妇保健 CHW 项目（36 个区）或标准护理区（24 个区）。2014 年 5 月至 8 月，我们对随机抽取的正处于孕期或产后不久的妇女进行了调查。我们采用五级李克特量表评估了妇女对 CHW 项目和达累斯萨拉姆公共部门卫生系统的满意度。

结果

共有 2329 名妇女参与了调查（应答率 90.2%）。干预区的家庭接受过 CHW 家访的可能性是对照组家庭的 2.3 倍（95% CI 1.8, 3.0）。该干预措施使表示对 CHW 项目满意或非常满意的妇女比例增加了 16 个百分点（95% CI 3, 30），对公共部门卫生系统满意的比例增加了 15 个百分点（95% CI 3, 27）。