Community Health Workers Clinical Trial
Official title:
Evaluation of a Mobile Application Tool for Increasing Community Health Worker Home Visit Coverage: A Randomized Controlled Study
Community Health Workers that work in collaboration with the NGO Muso Health and the Malian
government in both a peri-urban and a rural site in Mali, provide care proactively to the
population they form part of.
To work, they use a smartphone application that was developed as a job aid to support task
management, panel management and clinical decision support functions. For this study, a tool
called "Universal Health Coverage Mode" was designed to be integrated into the CHW
application to help Community Health Workers visit every household at least twice per month.
We hypothesize that Community Health Workers (CHWs) assigned to use Universal Health Coverage
(UHC) Mode, a mobile application tool, will achieve higher coverage of homes visited (defined
as being visited at least two times in a month) than those without this tool.
Community Health Workers participating in the study will be providing care through the
Proactive Community Case Management intervention, described in detail elsewhere. Through this
package of services, CHWs are required to conduct at least two hours of home visits per day,
six days per week, to achieve a goal of at least two home visits per household per month. All
CHWs receive monthly individual supervision via a 360 Supervision protocol, described in
detail elsewhere, as well as group supervisions weekly (at the Yirimadio site) or
twice-monthly (at the Tori site). At the Tori site, households served by each CHW were
previously registered via a population census which is updated every year by an independent
team of surveyors. Within the Yirimadio site, all households have been registered by the CHW
herself to achieve a ratio of approximately 1000 patients per CHW.
CHWs at both sites and both arms of the study will also receive monthly performance feedback
via a CHW Performance Dashboard, described elsewhere, which provides personalized feedback on
the quantity, speed, and coverage of care. CHW supervisors will be able to see their
supervisees' performance data and provide feedback via the monthly supervisions. CHWs at both
sites will receive feedback for community care management indicators, but only Yirimadio's
CHW supervisors will observe CHWs performance on proactive household visits.
All CHWs at both sites use a CHW App, a free and open source smartphone application developed
by Medic Mobile with Muso. The CHW App is a job aid that supports task management, panel
management, and clinical decision support functions, while providing a mechanism for data
collection and submission. Previously, CHWs had to manage 14 different types of paper forms
that their core workflow entails, and the data was entered by hand for each of these forms to
carry out monitoring and evaluation tasks. Now, there is no need for photocopying, carrying
and stocking all 14 forms, and data is automatically sent to a central database once the
smartphones are synchronized. Also, for CHW tracking their patients and the tasks they
performed meant a huge organizational challenge. The app was modeled to tackle this problem
using a human centered design, allowing the CHWs to easily search for and access their
patients registries and histories.
For the control arm, all households within the CHW's household list in the app will have the
same appearance. There will be no visual differentiation between households on the list to
indicate the frequency of home visits.
In the intervention arm, the CHW's household list will appear differently within the app in
the following ways:
The CHW will be able to filter and order households by the date of the most recent home
visit, to identify households that have been visited least frequently.
A color-coded visual icon will display the number of home visits in the past month for each
household.Red color for 0 home visits for a household in the past month (default at the start
of every month).Orange color for 1 home visit for a household in the past month.Blue color
for 2 or more visits for a household in the past month.
A red exclamation mark will be displayed for every household that has not reached 2 visits in
the past month (default at the start of every month).
Text displayed below each household showing the date of last visit will turn red if more than
30 days have passed since last visit. When more than 60 days have passed since the most
recent visit, the text displayed below each household showing the date of last visit will be
changed to "date of last visit is unknown" in red.
The family profile will also contain the date of last visit, and the visits they have
received in that month.
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