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A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries

BACKGROUND: A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effec...

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Autores principales: Kane, Sumit S, Gerretsen, Barend, Scherpbier, Robert, Dal Poz, Mario, Dieleman, Marjolein
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964693/
https://www.ncbi.nlm.nih.gov/pubmed/20942900
http://dx.doi.org/10.1186/1472-6963-10-286
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author Kane, Sumit S
Gerretsen, Barend
Scherpbier, Robert
Dal Poz, Mario
Dieleman, Marjolein
author_facet Kane, Sumit S
Gerretsen, Barend
Scherpbier, Robert
Dal Poz, Mario
Dieleman, Marjolein
author_sort Kane, Sumit S
collection PubMed
description BACKGROUND: A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we need to know how and when this comes to be. We examine evidence from randomized control trials (RCT) on CHW interventions in IMCI in LMIC from a realist perspective with the aim to see if they can yield insight into the working of the interventions, when examined from a different perspective. METHODS: The realist approach involves educing the mechanisms through which an intervention produced an outcome in a particular context. 'Mechanisms' are reactions, triggered by the interaction of the intervention and a certain context, which lead to change. These are often only implicit and are actually hypothesized by the reviewer. This review is limited to unravelling these from the RCTs; it is thus a hypothesis generating exercise. RESULTS: Interventions to improve CHW performance included 'Skills based training of CHW', 'Supervision and referral support from public health services', 'Positioning of CHW in the community'. When interventions were applied in context of CHW programs embedded in local health services, with beneficiaries who valued services and had unmet needs, the interventions worked if following mechanisms were triggered: anticipation of being valued by the community; perception of improvement in social status; sense of relatedness with beneficiaries and public services; increase in self esteem; sense of self efficacy and enactive mastery of tasks; sense of credibility, legitimacy and assurance that there was a system for back-up support. Studies also showed that if context differed, even with similar interventions, negative mechanisms could be triggered, compromising CHW performance. CONCLUSION: The aim of this review was to explore if RCTs could yield insight into the working of the interventions, when examined from a different, a realist perspective. We found that RCTs did yield some insight, but the hypotheses generated were very general and not well refined. These hypotheses need to be tested and refined in further studies.
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spelling pubmed-29646932010-10-28 A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries Kane, Sumit S Gerretsen, Barend Scherpbier, Robert Dal Poz, Mario Dieleman, Marjolein BMC Health Serv Res Research Article BACKGROUND: A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we need to know how and when this comes to be. We examine evidence from randomized control trials (RCT) on CHW interventions in IMCI in LMIC from a realist perspective with the aim to see if they can yield insight into the working of the interventions, when examined from a different perspective. METHODS: The realist approach involves educing the mechanisms through which an intervention produced an outcome in a particular context. 'Mechanisms' are reactions, triggered by the interaction of the intervention and a certain context, which lead to change. These are often only implicit and are actually hypothesized by the reviewer. This review is limited to unravelling these from the RCTs; it is thus a hypothesis generating exercise. RESULTS: Interventions to improve CHW performance included 'Skills based training of CHW', 'Supervision and referral support from public health services', 'Positioning of CHW in the community'. When interventions were applied in context of CHW programs embedded in local health services, with beneficiaries who valued services and had unmet needs, the interventions worked if following mechanisms were triggered: anticipation of being valued by the community; perception of improvement in social status; sense of relatedness with beneficiaries and public services; increase in self esteem; sense of self efficacy and enactive mastery of tasks; sense of credibility, legitimacy and assurance that there was a system for back-up support. Studies also showed that if context differed, even with similar interventions, negative mechanisms could be triggered, compromising CHW performance. CONCLUSION: The aim of this review was to explore if RCTs could yield insight into the working of the interventions, when examined from a different, a realist perspective. We found that RCTs did yield some insight, but the hypotheses generated were very general and not well refined. These hypotheses need to be tested and refined in further studies. BioMed Central 2010-10-13 /pmc/articles/PMC2964693/ /pubmed/20942900 http://dx.doi.org/10.1186/1472-6963-10-286 Text en Copyright ©2010 Kane et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Kane, Sumit S
Gerretsen, Barend
Scherpbier, Robert
Dal Poz, Mario
Dieleman, Marjolein
A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title_full A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title_fullStr A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title_full_unstemmed A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title_short A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
title_sort realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964693/
https://www.ncbi.nlm.nih.gov/pubmed/20942900
http://dx.doi.org/10.1186/1472-6963-10-286
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