CHAT: mHealth Innovation for HIV-MNCH Community Health Workers in South Africa

聊天：南非 HIV-MNCH 社区卫生工作者的移动医疗创新

基本信息

批准号：
8529620
负责人：
Lisa Michelle Butler
金额：
$ 27.71万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-15 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8529620
关键词：
5 year old Address Adherence Adult Affect Africa South of the Sahara African Age Behavior Caregivers Caring Cessation of life Child Child Care Child Development Child Mortality Child Nutrition Child health care Childhood Client Clinic Communication Communities Community Health Computer software Computers Continuity of Patient Care Country Data Development Devices Diarrhea Dietary Intervention Disease Education Effectiveness Ensure Evaluation Goals Growth Guidelines HIV HIV Infections Health Health Personnel Health Promotion Health Services Accessibility Health behavior Health care facility Health education Healthcare Home environment Household Hygiene Immunization Improve Access Infant Intervention Knowledge Learning Life Live Birth Logic Lower Respiratory Tract Infection Malnutrition Maternal and Child Health Modeling Mothers Nutritional Outcome Participant Play Prevalence Primary Health Care Protocols documentation Province Quality of Care Randomized Controlled Trials Research Resources Role Self-Help Devices Services South Africa Supervision Tablets Technology Testing Training Translating Underserved Population Validation Work animation base care seeking care systems community planning cost design effective intervention electronic data evidence base follow-up health care service utilization immune function improved information gathering innovation interest meetings mortality nutrition open source patient home care prevention service programs scale up success

项目摘要

DESCRIPTION (provided by applicant): In South Africa (SA), an estimated 51,300 children between 1 month and 5 years old die every year. -- the majority (57%) due to HIV. Childhood malnutrition, associated with diminished immune function, is a major contributor to these deaths. Key interventions to reduce HIV- and nutrition- related child mortality include well- defined and evidence-based packages of care to improve survival of HIV-infected adult caregivers as well as HIV-exposed children. Community health workers (CHW), if appropriately supported, can play a critical role in improving access to care and supporting delivery of evidence-based HIV and maternal and child health and nutritional (MCHN) interventions. While prior studies have shown the feasibility of CHW-led models for MCHN health promotion and their impact on some maternal-child health outcomes, evaluations of non-HIV focused CHW programs have shown CHW adherence to protocols to decline rapidly after training. Thus, despite the recognized importance of CHW models, there is little research to address the effectiveness of strategies for training CHW or for ensuring quality of care and fidelity to evidence-based protocols. We propose a 3-year study to develop and test an mHealth innovation to support CHW in their delivery of home-based HIV and MCHN education, support, and referral in a high HIV prevalence community in KwaZulu Natal, SA. Community Health Worker Assistive Technologies (CHAT) will be developed on a handheld platform (i.e., a multi-function tablet computer) and will leverage available, low-cost devices and open source software. CHAT will provide CHW with sustained, integrated support including protocol training, powerful handheld technologies and accessible, media enhanced resources (e.g., health education videos and animations) that will promote interactive discussions with clients. It will enable electronic data capture that supports high quality information gathering using data validation and branching logic, and will support communication with clinic-based health providers and CHW supervisors. To test the impact of CHAT, we will conduct a small community randomized controlled trial (C-RCT) to investigate the impact of CHAT on 1) CHW quality of care as well as knowledge about HIV, nutrition, danger signs of childhood illness, and child development; 2) health care utilization of caregivers for children, and child-care-related behaviors (e.g., immunizations, hygiene practices); and 3) the preliminary impact of CHAT on child health including growth, disease, and development for HIV-affected children age 0 to 59 months old. Participants will include 60 CHW (30 intervention, 30 control) and 80 caregiver-child pairs (40 intervention and 40 control) who will be followed for one year and assessed at regular intervals for the outcomes of interest. We will also assess the acceptability and feasibility of CHAT, conducting health and developmental assessments at children's homes, and translate lessons learned in the development study into the design of a large C-RCT.

描述（由申请人提供）：在南非 (SA)，估计每年有 51,300 名 1 个月至 5 岁的儿童死亡。 ——大多数（57%）是由艾滋病毒引起的。与免疫功能下降相关的儿童营养不良是造成这些死亡的主要原因。降低与艾滋病毒和营养相关的儿童死亡率的关键干预措施包括制定明确且基于证据的一揽子护理方案，以提高感染艾滋病毒的成年护理人员以及暴露于艾滋病毒的儿童的生存率。如果得到适当支持，社区卫生工作者 (CHW) 可以在改善获得护理的机会和支持提供循证艾滋病毒以及妇幼健康和营养 (MCHN) 干预措施方面发挥关键作用。虽然之前的研究表明，社区卫生工作者主导的妇幼保健院健康促进模式的可行性及其对一些母婴健康结果的影响，但对非艾滋病毒重点社区卫生工作者项目的评估表明，社区卫生工作者对方案的遵守程度在培训后会迅速下降。因此，尽管社区卫生工作者模型的重要性已得到公认，但很少有研究来解决社区卫生工作者培训策略的有效性或确保护理质量和对循证协议的忠诚度。我们提议开展一项为期 3 年的研究，开发和测试移动医疗创新，以支持 CHW 在南澳州夸祖鲁纳塔尔市的艾滋病毒高流行社区提供家庭艾滋病毒和 MCHN 教育、支持和转诊。社区卫生工作者辅助技术 (CHAT) 将在手持平台（即多功能平板电脑）上开发，并将利用可用的低成本设备和开源软件。 CHAT 将为 CHW 提供持续、综合的支持，包括协议培训、强大的手持技术和可访问的媒体增强资源（例如健康教育视频和动画），以促进与客户的互动讨论。它将实现电子数据采集，支持使用数据验证和分支逻辑进行高质量信息收集，并将支持与诊所医疗服务提供者和社区卫生工作者主管的沟通。为了测试 CHAT 的影响，我们将进行一项小型社区随机对照试验 (C-RCT)，以调查 CHAT 对以下方面的影响：1) CHW 护理质量以及有关艾滋病毒、营养、儿童疾病危险体征的知识，以及儿童发展； 2) 儿童护理人员的医疗保健利用情况以及与儿童保育相关的行为（例如免疫接种、卫生习惯）； 3) CHAT 对儿童健康的初步影响，包括 0 至 59 个月大的 HIV 感染儿童的生长、疾病和发育。参与者将包括 60 名社区卫生工作者（30 名干预组，30 名对照组）和 80 组看护者-儿童对（40 名干预组和 40 名对照组），他们将接受一对一跟踪每年并定期评估感兴趣的结果。我们还将评估 CHAT 的可接受性和可行性，在儿童之家进行健康和发育评估，并将发育研究中吸取的经验教训转化为大型 C-RCT 的设计。