Westgard Christopher M, Orrego-Ferreyros Luis A
Department of Research and Innovation, Elementos, Lima, Peru.
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLOS Glob Public Health. 2022 Sep 22;2(9):e0001118. doi: 10.1371/journal.pgph.0001118. eCollection 2022.
When community health workers (CHWs) are effective, they can teach healthy child rearing practices in their communities and improve child health and development outcomes. An effective mHealth tool can improve the capacity of CHWs to transmit knowledge to caregivers. This article evaluates the implementation of an mHealth tool in a CHW program in the Amazon of Peru. The intervention was designed, implemented, and evaluated with the guidance of multiple implementation science tools. A Hybrid Type 3 evaluation design was used to test the effectiveness of the implementation strategies and appropriateness of the intervention. The implementation outcomes: acceptability, adoption, dosage, and fidelity were analyzed with mixed methods approach to determine if the intervention was successfully installed in the CHW program. The service outcome, knowledge scores, was analyzed with an independent samples t-test and one way ANOVA to determine the effect of the program. The implementation strategies resulted in high degrees of acceptability, adoption, and fidelity of the mHealth tool. The surveillance component of the mHealth tools was not adequately adopted. The group of caregivers that received home visits with the mHealth tool (N = 48) had significantly higher knowledge scores (+1.26 standard deviations) than those in the control group (N = 138) (t(184) = -4.39, p<0.001). The COVID-19 pandemic significantly decreased the dosage of the intervention received by the participants. The CHEST App intervention is a promising tool to improve the capacity of CHWs during their home visits. Trial registered with ISRCTN on 11/29/2018 at https://doi.org/10.1186/ISRCTN43591826.
当社区卫生工作者（CHW）发挥有效作用时，他们可以在社区中传授健康的育儿方法，并改善儿童健康和发育成果。一款有效的移动健康（mHealth）工具可以提高社区卫生工作者向照料者传播知识的能力。本文评估了一款mHealth工具在秘鲁亚马逊地区的一个社区卫生工作者项目中的实施情况。该干预措施是在多种实施科学工具的指导下设计、实施和评估的。采用混合3型评估设计来测试实施策略的有效性和干预措施的适宜性。运用混合方法分析实施结果，即可接受性、采用率、剂量和保真度，以确定该干预措施是否成功纳入社区卫生工作者项目。使用独立样本t检验和单因素方差分析来分析服务结果（知识得分），以确定该项目的效果。实施策略使mHealth工具获得了高度的可接受性、采用率和保真度。mHealth工具的监测部分未得到充分采用。接受mHealth工具家访的照料者组（N = 48）的知识得分（比对照组（N = 138）高1.26个标准差）显著更高（t(184) = -4.39，p<0.001）。2019冠状病毒病疫情显著降低了参与者接受的干预剂量。CHEST应用程序干预是一种很有前景的工具，可以提高社区卫生工作者家访期间的能力。该试验于2018年11月29日在ISRCTN注册，网址为https://doi.org/10.1186/ISRCTN43591826。
