Premium
Análisis longitudinal de la adherencia de trabajadores sanitarios comunitarios a las guías de tratamiento, Siaya, Kenia, 1997–2002
Author(s) -
Rowe S. Y.,
Olewe M. A.,
Kleinbaum D. G.,
McGowan J. E.,
McFarland D. A.,
Rochat R.,
Deming M. S.
Publication year - 2007
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2007.01824.x
Subject(s) - medicine , psychological intervention , community health workers , longitudinal study , physical therapy , family medicine , population , environmental health , nursing , health services , pathology
Summary Objectives To investigate community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence. Methods Analysis of 7151 ill‐child consultations performed by 114 CHWs in their communities from March 1997–May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training. Results The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training. Conclusions The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.