Innovating home visiting to mothers and infants by community health workers: an action-oriented guide

Abstract Objectives: to describe the process of development and the structure of an action-oriented guide for home visits (HVs) to mothers and infants by Community Health Workers (CHWs). The guide was adopted in a controlled trial aimed at assessing its efficacy in improving CHWs' performance. Methods: steps to develop the guide included: 1) Review of international and national standards and recommendations for community interventions for maternal and child care; 2) Assessment of perceived needs of CHWs and other Family Health professionals regarding prenatal and postnatal HVs; 3) Identification of elements to construct the guide. Results: the Guide provides action-oriented instructions for 10 HVs during prenatal and postnatal period up to 9 months instead of the 18 HVs currently recommended by Ministry of Health. Specific tasks for each visit including assessment and promotion of early child development (ECD) and an action-oriented risk classification are introduced as standardized operational practice. Conclusions: the described approach to guide construction allows adapting the guide contents to the health system context in Brazil and other countries interested in improving quality of HVs by CHWs. The guide, by identifying tasks to be carried out and actions to be taken at each HV, provides an innovative approach and represents a requisite for a more efficient and effective use of their time

Visitas domiciliares inovadoras e a saúde materno‑infantil

Objetivo: Avaliar o efeito de um programa de Visitas Domiciliares Inovadoras (VDI), que é baseado em um guia de orientação, nos conhecimentos e práticas de saúde das mães em relação aos cuidados da criança e durante os períodos pré/pós-natal, e indicadores de saúde materno-infantil (ISMI). Métodos: Estudo transversal e analítico que comparou 195 gestantes e mães que receberam VDI (grupo 1) com o grupo 2, de visitas domiciliares convencionais (VDC), realizado em Unidades de Saúde da Família (USF) de Recife, Pernambuco, entre 2015 a 2016. Dividiram-se 16 equipes de saúde da família em dois grupos: oito equipes receberam treinamento para VDI e oito não receberam. Houve dez VDI com a utilização do guia, durante a gestação e durante os nove meses da criança. As VDC ocorreram uma vez/mês, durante o mesmo período das VDI, mas sem o guia. Após nove meses, as participantes foram entrevistadas através de questionário com conteúdos relacionados à saúde materno-infantil. Resultados: 93 gestantes (49 do grupo 1 e 44 do 2) e 102 mães de crianças (57 do grupo 1 e 45 do 2) responderam aos questionários. Os resultados mostraram melhores indicadores de pré-natal (p=0,005), melhor conhecimento sobre métodos contraceptivos (

Parenting of mothers of children in early childhood during the COVID-19 pandemic: qualitative research

ABSTRACT Objectives: to understand practices of mothers of children in early childhood who live in contexts of poverty in the face of the COVID-19 pandemic. Methods: an exploratory, descriptive and qualitative study. Participants were selected in the community context, composing an intentional sample to be collected through semi-structured online interviews. Data were analyzed inductively and anchored in the Bioecological Model of Human Development. Results: eight mothers participated in the research. Mothers highlighted pleasure in taking care of their children, although they were overloaded with activities and comprehensive care at the time of the pandemic. Children, in mothers’ perception, showed a higher frequency of challenging behaviors, which may be related to negative parenting practices, such as punishment and physical violence. Final Considerations: interventions to support parenting become urgent in the face of changes brought about by the COVID-19 pandemic in families living in a context of poverty

WHO standards-based tools to measure service providers' and service users' views on the quality of hospital child care: development and validation in Italy

Objectives Evidence showed that, even in high-income countries, children and adolescents may not receive high quality of care (QOC). We describe the development and initial validation, in Italy, of two WHO standards-based questionnaires to conduct an assessment of QOC for children and young adolescents at inpatient level, based on the provider and user perspectives. Design Multiphase, mixed-methods study. Setting, participants and methods The two questionnaires were developed in four phases equally conducted for each tool. Phase 1 which included the prioritisation of the WHO Quality Measures according to predefined criteria and the development of the draft questionnaires. In phase 2 content face validation of the draft questionnaires was assessed among both experts and end-users. In phase 3 the optimised questionnaires were field tested to assess acceptability, perceived utility and comprehensiveness (N=163 end-users). In phase 4 intrarater reliability and internal consistency were evaluated (N=170 and N=301 end-users, respectively). Results The final questionnaires included 150 WHO Quality Measures. Observed face validity was excellent (kappa value of 1). The field test resulted in response rates of 98% and 76% for service users and health providers, respectively. Among respondents, 96.9% service users and 90.4% providers rated the questionnaires as useful, and 86.9% and 93.9%, respectively rated them as comprehensive. Intrarater reliability was good, with Cohen's kappa values exceeding 0.70. Cronbach alpha values ranged from 0.83 to 0.95, indicating excellent internal consistency. Conclusions Study findings suggest these tools developed have good content and face validity, high acceptability and perceived utility, and good intrarater reliability and internal consistency, and therefore could be used in health facilities in Italy and similar contexts. Priority areas for future research include how tools measuring paediatric QOC can be more effectively used to help health professionals provide the best possible care

Innovating home visiting to mothers and infants by community health workers: an action-oriented guide

Abstract Objectives: to describe the process of development and the structure of an action-oriented guide for home visits (HVs) to mothers and infants by Community Health Workers (CHWs). The guide was adopted in a controlled trial aimed at assessing its efficacy in improving CHWs' performance. Methods: steps to develop the guide included: 1) Review of international and national standards and recommendations for community interventions for maternal and child care; 2) Assessment of perceived needs of CHWs and other Family Health professionals regarding prenatal and postnatal HVs; 3) Identification of elements to construct the guide. Results: the Guide provides action-oriented instructions for 10 HVs during prenatal and postnatal period up to 9 months instead of the 18 HVs currently recommended by Ministry of Health. Specific tasks for each visit including assessment and promotion of early child development (ECD) and an action-oriented risk classification are introduced as standardized operational practice. Conclusions: the described approach to guide construction allows adapting the guide contents to the health system context in Brazil and other countries interested in improving quality of HVs by CHWs. The guide, by identifying tasks to be carried out and actions to be taken at each HV, provides an innovative approach and represents a requisite for a more efficient and effective use of their time

Desempenho no teste do progresso e coeficiente de rendimento final de curso são preditores de aprovação na residência médica?

Introdução: O teste do progresso (TP) é uma avaliação longitudinal e com conteúdo de final de curso cujo objetivo é acompanhar o ganho de desempenho dos estudantes e auxiliar na gestão de currículo. O papel preditivo do TP nos processos seletivos ao final do curso de Medicina vem sendo estudado com grande interesse. Objetivo: Avaliar a associação do desempenho longitudinal dos estudantes de medicina no TP em um período de seis anos e do coeficiente de rendimento final no curso com a aprovação na seleção para Residência Médica (RM). Método: Estudo longitudinal desenvolvido na Faculdade Pernambucana de Saúde (FPS), onde foram acompanhadas as trajetórias de estudantes de medicina que concluíram o curso nos anos de 2018 e 2019 em relação ao desempenho no TP e coeficiente de rendimento final. Os dados foram extraídos da base de dados do registro acadêmico da FPS no sistema Lyceum. As informações sobre a realização e resultado no processo seletivo de RM foram obtidas no site da instituição organizadora. Para análise bivariada foi usado o teste Qui-quadrado de Pearson e o Teste exato de Fisher quando aplicado e foi utilizado teste T para comparação de médias. Foi considerado o nível de significância de 95%. Resultados: Foram avaliados 293 estudantes respeitando-se os critérios de inclusão/exclusão. A média de idade foi de 26,36 (±3,29) anos e com predomínio do sexo feminino (76%). Observou-se que 96 (33%) estudantes optaram por não ingressar imediatamente ao término do curso em programa de RM, e este comportamento esteve mais associado com a média de idade mais elevada no momento da conclusão do curso (p=0,02). Observou-se associação entre a média do TP e aprovação na RM (p<0,001), não sendo observada essa associação com o coeficiente de rendimento final (p=0,71). Conclusão: Este estudo mostrou associação entre o desempenho no TP ao longo dos seis anos do curso de Medicina e aprovação na prova de RM. Tal associação não foi identificada com o coeficiente de rendimento geral do curso. Destacamos a importância de atribuir motivação à realização do TP com cada vez mais destaque a sua função formativa e primordial no processo de aprendizagem.Introduction: the Progress Test (PT) is a longitudinal, end-of-course assessment that aims to track students’ performance gains and assist in curriculum management. The predictive role of the PT in the selection processes at the end of medical school has been studied with great interest. Objective: to evaluate the association of longitudinal performance of medical students in the PT over a six-year period and the final course performance coefficient with approval in the selection for Medical Residency (MR). Method: a longitudinal study developed at Pernambuco Health College (PHC), where the trajectories of medical students who completed the course in 2018 and 2019 were followed in relation to performance in the PT and final income coefficient. The data were extracted from the PHC academic record database in the Lyceum system. Information about the performance and result in the MR selectionprocess was obtained from the website of the organizing institution. For bivariate analysis Pearson’s chi-square test and Fisher’s exact test were used when applied, and T test was used to compare means. A significance level of 95% was considered. Results: 293 students were evaluated according to the inclusion/exclusion criteria. The mean agewas 26.36 (±3.29) years, with a predominance of females (76%). It was observed that 96 (33%) students chose not to enter immediately after finishing the course in an MR program, and this behavior was more associated with the higher mean age at the time of course completion (P = 0.02). An association was observed between average PT and passing in MR (p<0.001), and no such association was observed with the final yield coefficient (p=0.71).Conclusion: this study showed an association between performance in the PT over the six years of medical school and passing the MR test. Such association was not identified with the overall course performance coefficient. We emphasize the importance of motivating the performance of the PT with increasing emphasis on its formative and primordial function in the learning process

Effectiveness of an action-oriented educational intervention in ensuring long term improvement of knowledge, attitudes and practices of community health workers in maternal and infant health: a randomized controlled study

Abstract Background The potential role of Community Health Workers (CHWs) in improving maternal and child health outcomes, particularly in low and middle-income countries and in disadvantaged communities, is receiving increased attention. Adequate and focused training is among the key requisites for enhancing CHWs performances and research is necessary to identify effective training methods. Methods A randomized controlled study was designed to assess the effectiveness of a training course in improving knowledge, attitudes and practices (KAP) of CHWs regarding maternal and infant health. Seventy-eight CHWs belonging to Family Health Units in the city of Recife, Brazil were randomly allocated to intervention and control groups. The intervention group took part in a four-day interactive training course based on an action-oriented guide to perform home visits to pregnant women and their infants throughout pregnancy and infancy until 9 months of age. KAP in intervention group after training and after 1 year were compared to control group and to baseline. Results Fifty-nine CHWs completed all KAP assessments (31 in intervention and 28 in control group). Baseline characteristics were similar in both groups. At 1 year from training, the intervention group had higher overall KAP score (120.65 vs. 108.19, p <  0.001) as well as knowledge (47.45 vs. 40.54, p <  0.001), practice (53.45 vs. 49.11, p <  0.001) and attitudes scores (19.74 vs. 18.81, p = 0.047) than the control group. Moreover, at 1 year from training, the intervention group maintained significant improvements in overall KAP score (120.65 vs. 106.55, p <  0.001) as well as in knowledge (45.45 vs. 42.13, p <  0.001), and practice (53.45 vs. 45.29, p <  0.001) scores with respect to baseline. In the control group, overall KAP (106.59 vs. 108.19, p = 0.345) as well as separate knowledge, attitudes and practices scores remained unchanged. Conclusions A four-day interactive training course on action-oriented home visits to pregnant women and infants produced a sustained improvement of CHWs’ KAP and may represent a model to ensure retention of acquired competences. Trial registration RBR-9gchqr. Date registered: July 21, 2018 (Retrospectively registered)

Innovating home visiting to mothers and infants by community health workers: an action-oriented guide

Abstract Objectives: to describe the process of development and the structure of an action-oriented guide for home visits (HVs) to mothers and infants by Community Health Workers (CHWs). The guide was adopted in a controlled trial aimed at assessing its efficacy in improving CHWs' performance. Methods: steps to develop the guide included: 1) Review of international and national standards and recommendations for community interventions for maternal and child care; 2) Assessment of perceived needs of CHWs and other Family Health professionals regarding prenatal and postnatal HVs; 3) Identification of elements to construct the guide. Results: the Guide provides action-oriented instructions for 10 HVs during prenatal and postnatal period up to 9 months instead of the 18 HVs currently recommended by Ministry of Health. Specific tasks for each visit including assessment and promotion of early child development (ECD) and an action-oriented risk classification are introduced as standardized operational practice. Conclusions: the described approach to guide construction allows adapting the guide contents to the health system context in Brazil and other countries interested in improving quality of HVs by CHWs. The guide, by identifying tasks to be carried out and actions to be taken at each HV, provides an innovative approach and represents a requisite for a more efficient and effective use of their time