Can local staff reliably assess their own programs? A confirmatory test-retest study of Lot Quality Assurance Sampling data collectors in Uganda

Background Data collection techniques that routinely provide health system information at the local level are in demand and needed. LQAS is intended for use by local health teams to collect data at the district and sub-district levels. Our question is whether local health staff produce biased results as they are responsible for implementing the programs they also assess. Methods This test-retest study replicates on a larger scale an earlier LQAS reliability assessment in Uganda. We conducted in two districts an LQAS survey using 15 local health staff as data collectors. A week later, the data collectors swapped districts, where they acted as disinterested non-local data collectors, repeating the LQAS survey with the same respondents. We analysed the resulting two data sets for agreement using Cohens’ Kappa. Results The average Kappa score for the knowledge indicators was κ=0.43 (SD=0.16) and for practice indicators κ=0.63 (SD=0.17). These scores show moderate agreement for knowledge indicators and substantial agreement for practice indicators. Analyses confirm that respondents were more knowledgeable on retest; no evidence of bias was found for practices indicators. Conclusion The findings of this study are remarkably similar to those produced in the first reliability study. There is no evidence that using local healthcare staff to collect LQAS data biases data collection in an LQAS study. The bias observed in the knowledge indicators was most likely due to a ‘practice effect’, whereby respondents increased their knowledge as a result of completing the first survey; no corresponding effect was seen in the practice indicators

Applying a transformative consumer research lens to understanding and alleviating poverty

Increasing attention to global poverty and the development of market-based solutions for poverty alleviation continues to motivate a broad array of academicians and practitioners to better understand the lives of the poor. Yet, the robust perspectives residing within consumer research remain to a large degree under-utilized in these pursuits. This paper articulates how applying a transformative consumer research (TCR) lens to poverty and its alleviation can generate productive insights with potential to positively transform the well-being of poor consumers

Using Lot Quality Assurance Sampling to assess access to water, sanitation and hygiene services in a refugee camp setting in South Sudan: A feasibility study

Humanitarian agencies working in refugee camp settings require rapid assessment methods to measure the needs of the populations they serve. Due to the high level of dependency of refugees, agencies need to carry out these assessments. Lot Quality Assurance Sampling (LQAS) is a method commonly used in development settings to assess populations living in a project catchment area to identify their greatest needs. LQAS could be well suited to serve the needs of refugee populations, but it has rarely been used in humanitarian settings. We adapted and implemented an LQAS survey design in Batil refugee camp, South Sudan in May 2013 to measure the added value of using it for sub-camp level assessment

Associations with HIV testing in Uganda: an analysis of the Lot Quality Assurance Sampling database 2003–2012

Beginning in 2003, Uganda used Lot Quality Assurance Sampling (LQAS) to assist district managers collect and use data to improve their human immunodeficiency virus (HIV)/AIDS program. Uganda's LQAS-database (2003–2012) covers up to 73 of 112 districts. Our multidistrict analysis of the LQAS data-set at 2003–2004 and 2012 examined gender variation among adults who ever tested for HIV over time, and attributes associated with testing. Conditional logistic regression matched men and women by community with seven model effect variables. HIV testing prevalence rose from 14% (men) and 12% (women) in 2003–2004 to 62% (men) and 80% (women) in 2012. In 2003–2004, knowing the benefits of testing (Odds Ratio [OR] = 6.09, 95% CI = 3.01–12.35), knowing where to get tested (OR = 2.83, 95% CI = 1.44–5.56), and secondary education (OR = 3.04, 95% CI = 1.19–7.77) were significantly associated with HIV testing. By 2012, knowing the benefits of testing (OR = 3.63, 95% CI = 2.25–5.83), where to get tested (OR = 5.15, 95% CI = 3.26–8.14), primary education (OR = 2.01, 95% CI = 1.39–2.91), being female (OR = 3.03, 95% CI = 2.53–3.62), and being married (OR = 1.81, 95% CI = 1.17–2.8) were significantly associated with HIV testing. HIV testing prevalence in Uganda has increased dramatically, more for women than men. Our results concurred with other authors that education, knowledge of HIV, and marriage (women only) are associated with testing for HIV and suggest that couples testing is more prevalent than other authors

Additional file 1: of Can local staff reliably assess their own programs? A confirmatory test-retest study of Lot Quality Assurance Sampling data collectors in Uganda

0 to 5 months test. (XLSX 156 kb

Additional file 2: of Can local staff reliably assess their own programs? A confirmatory test-retest study of Lot Quality Assurance Sampling data collectors in Uganda

0 to 5 months retest. (XLSX 155 kb

Can health workers reliably assess their own work? A test-retest study of bias among data collectors conducting a Lot Quality Assurance Sampling survey in Uganda.

BACKGROUND Lot Quality Assurance Sampling (LQAS) is a classification method that enables local health staff to assess health programmes for which they are responsible. While LQAS has been favourably reviewed by the World Bank and World Health Organization (WHO), questions remain about whether using local health staff as data collectors can lead to biased data. METHODS In this test-retest research, Pallisa Health District in Uganda is subdivided into four administrative units called supervision areas (SA). Data collectors from each SA conducted an LQAS survey. A week later, the data collectors were swapped to a different SA, outside their area of responsibility, to repeat the LQAS survey with the same respondents. The two data sets were analysed for agreement using Cohens' kappa coefficient and disagreements were analysed. RESULTS Kappa values ranged from 0.19 to 0.97. On average, there was a moderate degree of agreement for knowledge indicators and a substantial level for practice indicators. Respondents were found to be systematically more knowledgeable on retest indicating bias favouring the retest, although no evidence of bias was found for practices indicators. CONCLUSIONS In this initial study, using local health care providers to collect data did not bias data collection. The bias observed in the knowledge indicators is most likely due to the 'practice effect', whereby respondents increased their knowledge as a result of completing the first survey, as no corresponding effect was seen in the practices indicators