Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA.
BMC Health Serv Res. 2019 Jul 24;19(1):516. doi: 10.1186/s12913-019-4205-z.
Suboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants.
We use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance.
Health worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge.
We find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.
医疗质量欠佳可能是改善儿童健康的障碍，但人们对提供者遵循循证实践与客户行为改变之间的关系知之甚少。我们评估了婴儿和幼儿喂养（IYCF）咨询背景下的提供者遵从情况、其与孟加拉国客户 IYCF 行为的关系，并探讨了其潜在决定因素。
我们使用了 2017 年 IYCF 方案评估的数据，该方案包括卫生工作者调查（n=74）、照顾者调查（n=232）和咨询课程直接服务观察清单（n=232 次对 74 名卫生工作者的观察）。我们使用多水平模型评估了提供者遵循推荐的 IYCF 咨询主题和行为（标准化为 100 分制）与客户报告的三种 IYCF 行为之间的关系，该模型在卫生工作者和分区（抽样）水平上具有随机效应。我们还评估了卫生工作者的自我效能、满意度和技术知识是否与提供者的遵从性相关。
卫生工作者的遵约情况与报告的 6 个月以下儿童纯母乳喂养显著相关（咨询遵约评分每增加 1 个百分点，调整后的比值比为 1.06，95%CI 1.01，1.12），与最低饮食多样性呈边缘相关（咨询遵约评分每增加 1 个百分点，调整后的比值比为 1.05，95%CI 1.00，1.11）。咨询遵约情况与卫生工作者的自我效能和技术知识呈显著正相关。
我们发现卫生工作者遵约情况与客户健康行为之间存在关联的证据；然而，较小的效应大小表明行为改变是多因素的，受到护理质量以外的因素影响。提高护理技术质量可能有助于实现预期的健康结果；但通过咨询寻求改变健康行为的政策和方案，可能也希望针对自我效能等上游因素，除技术技能建设和知识外，以实现最大影响。
