TY - JOUR
T1 - A cluster-randomized trial to test sharing histories as a training method for community health workers in Peru
AU - Altobelli, Laura C.
AU - Cabrejos-Pita, José
AU - Penny, Mary
AU - Becker, Stan
N1 - Funding Information:
This field project with embedded cluster randomized controlled trial research was made possible by a competitive grant to Future Generations from the United States Agency for International Development - Office of Global Health (Child Survival and Health Grants Program, Cooperative Agreement No. AID-OAA-10-00048) for the project Health in the Hands of Women: A Test of Teaching Methods in addition to support from the Carl E. Taylor Endowment for Equity and Empowerment, Future Generations University, and local government partners in Peru. The Maternal Health Task Force of EngenderHealth through a subgrant from the Bill and Melinda Gates Foundation (GMH-107-1) provided support to an earlier project in indigenous Andean villages of Cusco to adapt the sharing histories method to Peru. The views expressed in this article are the authors' and are not an official position of the funder.
Funding Information:
Funding: This field project with embedded cluster randomized controlled trial research was made possible by a competitive grant to Future Generations from the United States Agency for International Development – Office of Global Health (Child Survival and Health Grants Program, Cooperative Agreement No. AID-OAA-10-00048) for the project Health in the Hands of Women: A Test of Teaching Methods in addition to support from the Carl E. Taylor Endowment for Equity and Empowerment, Future Generations University, and local government partners in Peru. The Maternal Health Task Force of EngenderHealth through a subgrant from the Bill and Melinda Gates Foundation (GMH-107-1) provided support to an earlier project in indigenous Andean villages of Cusco to adapt the sharing histories method to Peru. The views expressed in this article are the authors’ and are not an official position of the funder.
Publisher Copyright:
© 2020 Johns Hopkins University Press. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Community health workers (CHWs) are increasingly deployed to support mothers' adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning. Methods: We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0-23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-forage (HAZ)<-2 Z-scores (stunting) in children aged 0-23 months. Household surveys were conducted at baseline (606 cases) and 4-year follow-up (606 cases). Results: Maternal and child characteristics were similar in both study arms at baseline and follow-up. Difference-in-differences analysis showed mean HAZ changes were not significantly different in experimental versus control clusters from baseline to endline (P=.469). However, in the subgroup of literate mothers, mean HAZ improved by 1.03 on the Z-score scale in experimental clusters compared to control clusters from baseline to endline (P=.059). Using generalized estimating equations, we demonstrated that stunting in children of mothers who were literate was significantly reduced (Beta=0.77; 95% confidence interval=0.23, 1.31; P<.01), adjusting for covariates. Conclusion: Compared with standard training methods, SH may have improved the effectiveness of CHWs as change agents among literate mothers to reduce child stunting. Stunting experienced by the children of illiterate mothers may have involved unaddressed determinants of stunting.
AB - Background: Community health workers (CHWs) are increasingly deployed to support mothers' adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning. Methods: We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0-23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-forage (HAZ)<-2 Z-scores (stunting) in children aged 0-23 months. Household surveys were conducted at baseline (606 cases) and 4-year follow-up (606 cases). Results: Maternal and child characteristics were similar in both study arms at baseline and follow-up. Difference-in-differences analysis showed mean HAZ changes were not significantly different in experimental versus control clusters from baseline to endline (P=.469). However, in the subgroup of literate mothers, mean HAZ improved by 1.03 on the Z-score scale in experimental clusters compared to control clusters from baseline to endline (P=.059). Using generalized estimating equations, we demonstrated that stunting in children of mothers who were literate was significantly reduced (Beta=0.77; 95% confidence interval=0.23, 1.31; P<.01), adjusting for covariates. Conclusion: Compared with standard training methods, SH may have improved the effectiveness of CHWs as change agents among literate mothers to reduce child stunting. Stunting experienced by the children of illiterate mothers may have involved unaddressed determinants of stunting.
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U2 - 10.9745/GHSP-D-19-00332
DO - 10.9745/GHSP-D-19-00332
M3 - Article
C2 - 33361239
AN - SCOPUS:85099074321
SN - 2169-575X
VL - 8
SP - 732
EP - 758
JO - Global Health Science and Practice
JF - Global Health Science and Practice
IS - 4
ER -