开发一种工具，用于评估南非基于社区的护理计划中社区卫生工作者提供的综合护理质量。
Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa.
机构信息
University of Warwick Warwick Medical School, Coventry, UK
Centre for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.
出版信息
BMJ Open. 2019 Sep 5;9(9):e030677. doi: 10.1136/bmjopen-2019-030677.
OBJECTIVE
To develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.
DESIGN
We determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.
SETTING
South Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.
PRIMARY AND SECONDARY OUTCOMES
Our primary outcome was the completion of a tool and user manual.
RESULTS
The tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.
CONCLUSIONS
We have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.
目的
为非临床领域工作者开发一种工具，用于评估在中低收入国家的家庭中提供综合护理的社区卫生工作者提供的护理质量。
设计
我们使用多种信息来源确定了工具的内容，包括与地区经理的互动、国家培训手册和一项探索性研究，该研究包括观察 70 名社区卫生工作者在进行 518 次家访时的情况，这些数据是作为一项更广泛研究的一部分收集的。我们还回顾了相关文献，选择了相关领域和质量标志物。为了完善工具和手册，我们与进行了观察的实地工作者合作。我们构建了两个分数来总结护理的关键方面：（1）在家庭访问期间传递信息和采取行动，（2）与家庭沟通；我们还收集了背景数据。实地工作者在另一个地区与社区卫生工作者一起使用该工具进行了可行性测试。
地点
南非，那里已经将社区卫生工作者纳入公共卫生系统，以解决卫生工作者短缺和医疗服务有限的问题。它被嵌入到一项旨在提高社区卫生工作者监督质量的干预研究中。
主要和次要结果
我们的主要结果是完成工具和用户手册。
结果
该工具由四个部分组成，在社区卫生工作者家访的不同阶段完成：出发前、进入家庭时、家访期间和离开家庭后。在工具完善后，我们在现场测试工具时没有发现问题。
结论
我们已经开发了一种用于评估社区卫生工作者家访时提供的护理质量的工具，这通常是他们角色中未被观察到的一部分。该工具是为评估干预措施而开发的，但也可用于支持社区卫生工作者的培训和管理。
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