Staehelin Dario, Schmid Damaris, Gerber Felix, Dolata Mateusz, Schwabe Gerhard
Department for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland.
Department of Informatics, University of Zurich, Zurich, Switzerland.
JMIR Hum Factors. 2025 Apr 23;12:e57545. doi: 10.2196/57545.
The World Health Organization anticipates a shortage of 14 million health workers by 2030, particularly affecting the Global South. Community health workers (CHWs) may mitigate the shortages of professional health care workers. Recent studies have explored the feasibility and effectiveness of shifting noncommunicable disease (NCD) services to CHWs. Challenges, such as high attrition rates and variable performance, persist due to inadequate organizational support and could hamper such efforts. Research on employee empowerment highlights how organizational structures affect employees' perception of empowerment and retention.
This study aims to develop Scripted Medicine to empower CHWs to accept broader responsibilities in NCD care. It aims to convey relevant medical and counseling knowledge through medical algorithms and ThinkLets (ie, social scripts). Collaboration engineering research offers insights that could help address the structural issues in community-based health care and facilitate task shifting.
This study followed a design science research approach to implement a mobile health-supported, community-based intervention in 2 districts of Lesotho. We first developed the medical algorithms and ThinkLets based on insights from collaboration engineering and algorithmic management literature. We then evaluated the designed approach in a field study in the ComBaCaL (Community Based Chronic Disease Care Lesotho) project. The field study included 10 newly recruited CHWs and spanned over 2 weeks of training and 12 weeks of field experience. Following an abductive approach, we analyzed surveys, interviews, and observations to study how Scripted Medicine empowers CHWs to accept broader responsibilities in NCD care.
Scripted Medicine successfully conveyed the required medical and counseling knowledge through medical algorithms and ThinkLets. We found that medical algorithms predominantly influenced CHWs' perception of structural empowerment, while ThinkLets affected their psychological empowerment. The different perceptions between the groups of CHWs from the 2 districts highlighted the importance of considering the cultural and economic context.
We propose Scripted Medicine as a novel approach to CHW empowerment inspired by collaboration engineering and algorithmic management. Scripted Medicine broadens the perspective on mobile health-supported, community-based health care. It emphasizes the need to script not only essential medical knowledge but also script counseling expertise. These scripts allow CHWs to embed medical knowledge into the social interactions in community-based health care. Scripted Medicine empowers CHW to accept broader responsibilities to address the imminent shortage of medical professionals in the Global South.
世界卫生组织预计，到2030年，卫生工作者将短缺1400万，全球南方地区受到的影响尤为严重。社区卫生工作者（CHW）或许可以缓解专业医护人员短缺的问题。最近的研究探讨了将非传染性疾病（NCD）服务转移给社区卫生工作者的可行性和有效性。由于组织支持不足，诸如高流失率和表现参差不齐等挑战依然存在，可能会阻碍此类努力。关于员工赋权的研究凸显了组织结构如何影响员工对赋权和留任的认知。
本研究旨在开发“脚本化医学”，使社区卫生工作者能够在非传染性疾病护理中承担更广泛的责任。它旨在通过医学算法和思维框架（即社会脚本）传达相关的医学和咨询知识。协作工程研究提供了一些见解，有助于解决社区医疗保健中的结构性问题并促进任务转移。
本研究采用设计科学研究方法，在莱索托的两个地区实施了一项由移动健康支持的社区干预措施。我们首先根据协作工程和算法管理文献中的见解开发了医学算法和思维框架。然后，我们在“基于社区的莱索托慢性病护理”（ComBaCaL）项目的实地研究中评估了所设计的方法。实地研究包括10名新招募的社区卫生工作者，涵盖了为期2周的培训和12周的实地经验。我们采用溯因法，分析了调查、访谈和观察结果，以研究“脚本化医学”如何使社区卫生工作者在非传染性疾病护理中承担更广泛的责任。
“脚本化医学”通过医学算法和思维框架成功传达了所需的医学和咨询知识。我们发现，医学算法主要影响社区卫生工作者对结构性赋权的认知，而思维框架则影响他们的心理赋权。来自两个地区的社区卫生工作者群体之间的不同认知凸显了考虑文化和经济背景的重要性。
我们提出“脚本化医学”是一种受协作工程和算法管理启发的社区卫生工作者赋权新方法。“脚本化医学”拓宽了对由移动健康支持的社区医疗保健的视角。它强调不仅要编写基本医学知识的脚本，还要编写咨询专业知识的脚本。这些脚本使社区卫生工作者能够将医学知识融入社区医疗保健中的社会互动中。“脚本化医学”使社区卫生工作者有能力承担更广泛的责任，以应对全球南方迫在眉睫的医疗专业人员短缺问题。
