TY - JOUR
T1 - Novel approaches to measuring knowledge among frontline health workers in India
T2 - Are phone surveys a reliable option?
AU - Shah, Neha
AU - Mohan, Diwakar
AU - Agarwal, Smisha
AU - Scott, Kerry
AU - Chamberlain, Sara
AU - Bhatnagar, Aarushi
AU - Labrique, Alain
AU - Indurkar, Meenal
AU - Ved, Rajani
AU - LeFevre, Amnesty
AU - Smisha Agarwal, Agarwal
AU - Salil Arora, Arora
AU - Jjh Bashingwa, Bashingwa
AU - Aarushi Bhatanagar, Bhatanagar
AU - Sara Chamberlain, Chamberlain
AU - Rakesh Chandra, Chandra
AU - Arpita Chakraborty, Chakraborty
AU - Vinod Chauhan, Chauhan
AU - Neha Dumke, Dumke
AU - Priyanka Dutta, Dutta
AU - Anna Godfrey, Godfrey
AU - Suresh Gopalakrishnan, Gopalakrishnan
AU - Meenal Indurkar, Indurkar
AU - Anushree Jairath, Jairath
AU - Manoj Kashyap, Kashyap
AU - Nayan Kumar, Kumar
AU - Simone Honikman, Honikman
AU - Alain Labrique, Labrique
AU - Amnesty LeFevre, LeFevre
AU - Jai Mendiratta, Mendiratta
AU - Molly Miller, Miller
AU - Radharani Mitra, Mitra
AU - Diwakar Mohan, Mohan
AU - Deshen Moodley, Moodley
AU - Nicola Mulder, Mulder
AU - Angela Ng, Ng
AU - Dilip Parida, Parida
AU - Nehru Penugonda, Penugonda
AU - Nikita Purty, Purty
AU - Sai Rahul, Rahul
AU - Shiv Rajput, Rajput
AU - Haritha Reddy, Reddy
AU - Agrima Sahore, Sahore
AU - Kerry Scott, Scott
AU - Neha Shah, Shah
AU - Manjula Sharma, Sharma
AU - Aashaka Shinde, Shinde
AU - Aaditya Singh, Singh
AU - Nicki Tiffin, Tiffin
AU - Osama Ummer, Ummer
AU - Rajani Ved, Ved
AU - Falyn Weiss, Weiss
AU - Sonia Whitehead, Whitehead
AU - Shalini Yadav, Yadav
N1 - Publisher Copyright:
© 2020 Shah et al.
PY - 2020/6
Y1 - 2020/6
N2 - Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs' knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Conclusions Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
AB - Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs' knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Conclusions Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
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U2 - 10.1371/journal.pone.0234241
DO - 10.1371/journal.pone.0234241
M3 - Article
C2 - 32598348
AN - SCOPUS:85087325292
SN - 1932-6203
VL - 15
JO - PLoS One
JF - PLoS One
IS - 6 June
M1 - e0234241
ER -