Dal Santo Leila C, Rastagar Sayed Haroon, Hemat Shafiqullah, Alami Sayed Omar, Pradhan Subarna, Tharaldson Jenae, Dulli Lisa S, Todd Catherine S
Global Health, Population, & Nutrition Division, FHI 360, Durham, North Carolina USA.
Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, Massachusetts 02467 USA.
Confl Health. 2020 Aug 5;14:56. doi: 10.1186/s13031-020-00302-z. eCollection 2020.
Rural Afghan populations have low skilled birth attendance rates and high maternal and infant mortality. Insecurity and armed conflict, geographic barriers, and cultural norms often hinder women's access to facility-based reproductive, maternal, newborn, and child health (RMNCH) services. Community health workers (CHWs) are critical agents for behavioral change in this and similarly fragile settings, where RMNCH information exposure is limited by low literacy and mass media access. We assessed the feasibility and acceptability of a computer tablet-based health video library (HVL) to enhance CHW counseling on RMNCH topics in three rural Afghan districts.
The HVL was introduced by trained CHWs in 10 pilot communities within one rural district in each of Balkh, Herat, and Kandahar provinces. We used a mixed-methods study design to assess exposure to and perception of the HVL 6 months post-introduction. We surveyed married women ( = 473) and men ( = 468) with at least one child under 5 years and conducted in-depth interviews with CHWs and community leaders ( and Family Health Action groups) within pilot communities ( = 80). Program improvement needs were summarized using quantitative and qualitative data.
Higher proportions of women in Balkh (60.3%) and Herat (67.3%) reported viewing at least one HVL video compared to women in Kandahar (15%), while male HVL exposure was low (8-17%) across all districts. Most HVL-exposed clients (85-93% of women and 74-92% of men) reported post-video counseling by CHWs. Nearly all (94-96% of women and 85-92% of men) were very interested in watching videos on other health topics in the future. Participants recommended increasing the number of videos and range of topics, using tablets with larger screens, and translating videos into additional local languages to improve the HVL program.
The HVL was a highly acceptable tool for relaying health information, but coverage of female audiences in Kandahar and male audiences broadly was low. The HVL should better engage men and other key influencers to engineer local solutions that directly facilitate male HVL exposure, indirectly improve women's HVL access, and support collaborative spousal health decision-making. A larger efficacy trial is warranted to measure the HVL's effect on knowledge and health-related behavioral outcomes.
阿富汗农村人口熟练接生率较低，孕产妇和婴儿死亡率较高。不安全和武装冲突、地理障碍以及文化规范常常阻碍妇女获得基于设施的生殖、孕产妇、新生儿和儿童健康（RMNCH）服务。在这种以及类似的脆弱环境中，社区卫生工作者（CHW）是行为改变的关键推动者，在这些地方，RMNCH信息的传播因识字率低和大众媒体获取受限而受到限制。我们评估了一个基于电脑平板电脑的健康视频库（HVL）在阿富汗三个农村地区加强CHW关于RMNCH主题咨询的可行性和可接受性。
由经过培训的CHW在巴尔赫、赫拉特和坎大哈三省每个省的一个农村地区的10个试点社区引入HVL。我们采用混合方法研究设计来评估引入后6个月对HVL的接触情况和看法。我们对至少有一个5岁以下孩子的已婚妇女（n = 473）和男子（n = 468）进行了调查，并对试点社区内的CHW和社区领袖（n = 80）以及家庭健康行动小组进行了深入访谈。使用定量和定性数据总结项目改进需求。
与坎大哈的妇女（15%）相比，巴尔赫（60.3%）和赫拉特（67.3%）观看过至少一个HVL视频的妇女比例更高，而所有地区男性对HVL的接触率都很低（8 - 17%）。大多数接触过HVL的服务对象（85 - 93%的妇女和74 - 92%的男子）报告接受了CHW的视频后咨询。几乎所有（94 - 96%的妇女和85 - 92%的男子）都对未来观看其他健康主题的视频非常感兴趣。参与者建议增加视频数量和主题范围，使用屏幕更大的平板电脑，并将视频翻译成更多当地语言以改进HVL项目。
HVL是传播健康信息的一个高度可接受的工具，但坎大哈女性受众以及总体男性受众的覆盖面较低。HVL应更好地吸引男性和其他关键影响者，以设计出直接促进男性接触HVL、间接改善女性接触HVL的机会并支持配偶共同做出健康决策的本地解决方案。有必要进行一项更大规模的疗效试验，以衡量HVL对知识和健康相关行为结果的影响。
