Improving Community Health Worker Performance With a Supervision Dashboard

Sponsor

Ari Johnson, MD (Other)

Overall Status

Completed

CT.gov ID

NCT03684551

Collaborator

Muso, Bamako Mali and San Francisco USA (Other), Malaria Research and Training Center, Bamako, Mali (Other), University of California, San Francisco (Other), Harvard Medical School (HMS and HSDM) (Other), Medic Mobile, San Francisco, USA (Other), Malian Ministry of Health and Public Hygiene (Other)

148

Enrollment

Arms

Actual Duration (Months)

Study Details

Study Description

Brief Summary

Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. This randomised controlled trial aims to determine the effect of a personalised performance dashboard used as a supervision tool on the quantity, speed, and quality of CHW care. This study is a randomised controlled trial in a large health catchment area in peri-urban Mali. One hundred forty-eight CHWs conducting proactive case-finding home visits were randomly allocated to receive individual monthly supervision with or without the CHW Performance Dashboard from January to June 2016. Randomisation was stratified by CHW supervisor, level of CHW experience, and CHW baseline performance for monthly quantity of care (number of household visits). With regression analysis, we used a difference-in-difference model to estimate the effect of the intervention on monthly quantity, timeliness (percentage of children under five treated within 24 hours of symptom onset), and quality (percentage of children under five treated without protocol error) of care over a six-month post-intervention period relative to a three-month pre-intervention period.

Condition or Disease	Intervention/Treatment	Phase
Community Health Worker Performance	Other: The CHW-led health system Other: The CHW Supervision model Other: The CHW Performance Dashboard	N/A

Study Design

Study Type:

Interventional

Actual Enrollment :

148 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Health Services Research

Official Title:

Improving Community Health Worker Performance by Using a Personalised Feedback Dashboard for Supervision: a Randomised Controlled Trial

Actual Study Start Date :

Nov 1, 2015

Actual Primary Completion Date :

Jun 30, 2016

Actual Study Completion Date :

Oct 31, 2016

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: No dashboard supervision tool CHWs received monthly individual supervision from a dedicated CHW supervisor. The supervisory feedback session for CHWs in the control arm was not facilitated by a visual Dashboard tool or any personalised quantitative feedback on quantity, speed, or quality of care. CHW supervisors were instructed to continue providing CHWs in the control arm with feedback informed by patient perspectives and direct observation during the individual supervision visit.	Other: The CHW-led health system During the study period, all CHWs, regardless of treatment arm, performed proactive case detection, the process of conducting at least two hours per day of door-to-door home visits to proactively identify - through health history inquiry and/or disease diagnostics - patients who need care. For all patients identified, CHWs provided doorstep counselling, evaluation, diagnostics, treatment, referral to appropriate health facilities, and follow-up. CHWs provided care in the community without user fees, and were able to refer patients to the reinforced government primary health centres for care without user fees as well. CHWs were residents of the communities they served, and they were required to be available at home or by phone for consultation at any time. Other: The CHW Supervision model CHWs in both study arms received monthly individual supervisory sessions and weekly group supervisory sessions from their dedicated CHW supervisor. An individual monthly session of 360 Supervision included: (i) solicitation of patient perspectives of CHW care; (ii) direct observation of CHW doorstep care; and (iii) a one-on-one feedback discussion with or without the CHW Performance Dashboard depending on treatment arm.
Experimental: Dashboard supervision tool CHWs received monthly individual supervision from a dedicated CHW supervisor. For CHWs randomised to the intervention arm, a visual feedback tool, the CHW Performance Dashboard, was employed during individual supervision, starting in January 2016. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month. The feedback provided to CHWs in the intervention arm, therefore, was both quantitative, informed by the Dashboard, and qualitative, informed by patient perspectives and direct observation of CHW service provision during the individual supervision visit.	Other: The CHW-led health system During the study period, all CHWs, regardless of treatment arm, performed proactive case detection, the process of conducting at least two hours per day of door-to-door home visits to proactively identify - through health history inquiry and/or disease diagnostics - patients who need care. For all patients identified, CHWs provided doorstep counselling, evaluation, diagnostics, treatment, referral to appropriate health facilities, and follow-up. CHWs provided care in the community without user fees, and were able to refer patients to the reinforced government primary health centres for care without user fees as well. CHWs were residents of the communities they served, and they were required to be available at home or by phone for consultation at any time. Other: The CHW Supervision model CHWs in both study arms received monthly individual supervisory sessions and weekly group supervisory sessions from their dedicated CHW supervisor. An individual monthly session of 360 Supervision included: (i) solicitation of patient perspectives of CHW care; (ii) direct observation of CHW doorstep care; and (iii) a one-on-one feedback discussion with or without the CHW Performance Dashboard depending on treatment arm. Other: The CHW Performance Dashboard The CHW Performance Dashboard was a graphic display of a CHW's performance along three indicators defined as follows: (i) "Quantity" of care: the number of homes visited during the month; (ii) "Timeliness" of care: the percentage of sick children under five treated within 24 hours of symptom onset during the month; (iii) "Quality" of care: the percentage of sick children under five treated without protocol error among 23 potential errors during the month. The Dashboard displayed an individual CHW's quantity, timeliness, and quality of care indicators from the previous month, using absolute numbers, percentages, and visual graphics, alongside those of the highest performing CHW. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month.

Arm

Intervention/Treatment

Active Comparator: No dashboard supervision tool

CHWs received monthly individual supervision from a dedicated CHW supervisor. The supervisory feedback session for CHWs in the control arm was not facilitated by a visual Dashboard tool or any personalised quantitative feedback on quantity, speed, or quality of care. CHW supervisors were instructed to continue providing CHWs in the control arm with feedback informed by patient perspectives and direct observation during the individual supervision visit.

Other: The CHW-led health system

During the study period, all CHWs, regardless of treatment arm, performed proactive case detection, the process of conducting at least two hours per day of door-to-door home visits to proactively identify - through health history inquiry and/or disease diagnostics - patients who need care. For all patients identified, CHWs provided doorstep counselling, evaluation, diagnostics, treatment, referral to appropriate health facilities, and follow-up. CHWs provided care in the community without user fees, and were able to refer patients to the reinforced government primary health centres for care without user fees as well. CHWs were residents of the communities they served, and they were required to be available at home or by phone for consultation at any time.

Other: The CHW Supervision model

CHWs in both study arms received monthly individual supervisory sessions and weekly group supervisory sessions from their dedicated CHW supervisor. An individual monthly session of 360 Supervision included: (i) solicitation of patient perspectives of CHW care; (ii) direct observation of CHW doorstep care; and (iii) a one-on-one feedback discussion with or without the CHW Performance Dashboard depending on treatment arm.

Experimental: Dashboard supervision tool

CHWs received monthly individual supervision from a dedicated CHW supervisor. For CHWs randomised to the intervention arm, a visual feedback tool, the CHW Performance Dashboard, was employed during individual supervision, starting in January 2016. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month. The feedback provided to CHWs in the intervention arm, therefore, was both quantitative, informed by the Dashboard, and qualitative, informed by patient perspectives and direct observation of CHW service provision during the individual supervision visit.

Other: The CHW-led health system

Other: The CHW Supervision model

Other: The CHW Performance Dashboard

The CHW Performance Dashboard was a graphic display of a CHW's performance along three indicators defined as follows: (i) "Quantity" of care: the number of homes visited during the month; (ii) "Timeliness" of care: the percentage of sick children under five treated within 24 hours of symptom onset during the month; (iii) "Quality" of care: the percentage of sick children under five treated without protocol error among 23 potential errors during the month. The Dashboard displayed an individual CHW's quantity, timeliness, and quality of care indicators from the previous month, using absolute numbers, percentages, and visual graphics, alongside those of the highest performing CHW. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month.

Outcome Measures

Primary Outcome Measures

Quantity of care [9 months]
The number of proactive case-finding home visits during the month

Secondary Outcome Measures

Timeliness of care [9 months]
The percentage of sick children under five treated within 24 hours of symptom onset during the month
Quality of care [9 months]
The percentage of sick children under five treated without protocol error among 23 potential errors during the month

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 45 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

To be a CHW in the study site at the time of enrolment (n=148)

Exclusion Criteria:

CHW who pretested the Dashboard tool (n=2)

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

Ari Johnson, MD
Muso, Bamako Mali and San Francisco USA
Malaria Research and Training Center, Bamako, Mali
University of California, San Francisco
Harvard Medical School (HMS and HSDM)
Medic Mobile, San Francisco, USA
Malian Ministry of Health and Public Hygiene

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Ari Johnson, MD, Assistant Professor, University of California, San Francisco

ClinicalTrials.gov Identifier:

NCT03684551

Other Study ID Numbers:

1015-0616

First Posted:

Sep 25, 2018

Last Update Posted:

Sep 25, 2018

Last Verified:

Sep 1, 2018

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Ari Johnson, MD, Assistant Professor, University of California, San Francisco

Community Health Worker

Health worker supervision

Mali

Randomized controlled trial

Study Results

No Results Posted as of Sep 25, 2018