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Problem Statement
Health education - central to preventive and promotive health services in primary care
Health education is globally a component of Primary Healthcare 1
When talking of health educators, HE is their exclusive job role
HE sessions in our setting are as a rule going un -assessed and un – monitored or in a poorly monitored form
Magnitude of the problem
Recent statistics on a few relevant health indicators are cited below:
1. Under five mortality: 100/1000 live births
2. IMR: 76/1000 live births
3. Child immunization: 70%
4. Exclusive breastfeeding: 45%
5. MMR: 320/100 000 live births
6. CPR: 38%
7. Skilled birth attendance: 42%
8. Antenatal care: 47% 2
HFs and schools are the usual community based venues of HE
HE mostly happens as a group activity
Target audiences are often poor, rural people mostly illiterate or with low literacy level
Priority themes/subthemes of HE
1. Birth spacing
2. Regular antenatal check up and skilled birth attendance
3. Danger signs of pregnancy
4. Diet during pregnancy and lactation
5. Breastfeeding and weaning
6. Immunization
7. Growth Monitoring up to first 3 years of life
8. ORS use during diarrhea 3
*UNICEF’s Facts for Life will be used as reference for Issue Specific Key Messages
Context
Workplace based assessment of HE sessions with the help of this assessment tool
Public & private sector static community clinics in flood affected districts (Charsadda and Nowshera)
Plus point is that CHS itself got four static clinics in flood affected districts including these districts (they may serve as control)
Uses
Workplace based assessment of various cadre community educators, including lady health workers
Formative and summative assessment of medical students:
1. As workplace based assessment in community
2. On practical stations, and
3. Mini CEX
Questions in the mind?
What are the priority competencies for a health educator?
Is there any pre - existing tool to measure those?
If not, what about developing an indigenous one? And
Pilot test it for reliability assessment and validation
Literature Search
Search done for HE skills, competencies and assessment formats
List of skills returned on search included:
1. Cultural competency skills
2. Communication and interpersonal skills
3. Negotiation/Refusal skills
4. Cooperation and teamwork skills
5. Advocacy skills
6. Critical thinking skills
7. Decision making skills
8. Problem solving skills, and
9. Coping and self management skills 4
Search ---
Assessment format was found on communication for training
No format was found for the target HE skills
However there were:
1. Guidelines to assess cultural competence of organizations
2. Standards to evaluate organizational competence for health promotion
3. Standard formats of IEC material, and
4. Check lists for patient education in clinical setting
Scope of the tool
Its doesn’t claim comprehensive assessment of all the HE competencies/skills at all
Its focus is on assessing HE skills necessary for effective conduction of community based HE sessions
These include:
1. Time management skills
2. Organizational skills
3. Cultural skills, and
4. Communication skills to effectively get across the issue specific key messages to community groups
Rating scaleSKILL ITEMS
Cultural skills 1. Session takes care of socio - cultural norms
2. People are greeted in culturally appropriate way
3. Session breaks for prayer well in time (skip if NA)
Time management skills 4. Session duration is shared at start
5. Session closes on time
Organizational skills 6. Overall organization for the session is appropriate
7. Support material is at hand
8. Support material is pre deployed at right place(s)
Communication skills 9. Introduces self appropriately
10. Shares purpose of the session
11. Maintains eye contact with the group
12. Non verbal cues match the verbal communication
13. Explains technical term(s) in easy language (skip if NA)
Scale ---SKILL Item
Communication skills 14. Communicates in an easy lay language
15. Remains on theme largely
16. Don’t prolong unnecessarily
17. Appropriately delivers key messages on the issue
18. Takes help of the support material appropriately
19. All the key messages are delivered appropriately
20. Demonstrates the procedure appropriately (skip if NA)
21. Takes feedback on key messages appropriately
22. Takes proper feedback of the procedure (skip if NA)
23. Encourages to ask questions
24. Responds to questions appropriately
25. Clarifies appropriately where needed (skip if NA)
26. Avoids unnecessary lengthy discussion
27. Informs about sources to take help from (skip if NA)
Rubric
1 = Poor
2 = Borderline poor
3 = Borderline satisfactory
4 = Satisfactory
5 = Good
6 = Excellent
7 = Outstanding
Assessment type and scoring
Formative assessment
Low stakes assessment
Coupled with feedback
Other than skip items, should meet at minimum the satisfactory for all of the items
Reliability Assurance
Items are clear
Items are not double barreled
Total number of items exceed 20
Several items check for key concepts/constructs
Training of the study team
Pilot testing the study team and tool
Multiple observations
Multiple raters
Reliability analysis
For internal consistency: ICC
Inter item correlation
Item to total correlation
Split half reliability (Cronbach alpha)
Test retest reliability
For inter rater reliability: Pearson Correlation
Validation methods
Face Validation: Seeking experts’ opinion Content validation:
1. Experts
2. Relevant literature
Construct validation:
1. Relevant literature
2. Experts
Consequent validation:
- Piloting, Repeated field tests
Minimizing Bias
Clear items
No double barreled items
Appropriate phrasing of items
Easy to follow
Not too lengthy
No or minimum recall items
Training the observers; pre testing the raters and tool at pilot
Ethical considerations
Informed consent for assessment from the assessed
Non sharing of the assessment with non concerned ones
Non disclosure of identity of the assessed
References
1. WHO / UNICEF: Alma Ata Declaration, 1978
2. UNICEF: Multiple Indicators Cluster Survey, 2008
3. UNICEF, WHO, UNESCO, UNFPA, UNDP & UNAIDS: Facts for Life, 3rd Edition, 2002
4. WHO: Information Series on School Health, Document No. 9 of 2001