An Evaluation of the UNICEF Cholera Toolkit: Assessing the Effectiveness and Usability Among UNICEF Staff and Partners Open Access

Chalker, Chad (2017)

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Background: UNICEF provides technical expertise in advocacy, coordination, assessments, surveillance, and communication for cholera prevention, preparedness, and response. In 2013, the UNICEF Cholera Toolkit was published to help prevent, prepare, and respond to cholera outbreaks. Since the publication, there has not been a comprehensive evaluation of the use and effectiveness of the toolkit among those who use or are aware of it.

Purpose: The objective of this evaluation was to describe how useful and effective the toolkit was to UNICEF staff and partners, understand which sections of the toolkit were most used, and understand if the dissemination process of the toolkit was effective to reach the target audience. Results and conclusions from this evaluation will be given to UNICEF to help inform information to include in future versions of the toolkit.

Methods: An online survey of 39 questions was sent to a non-probability, convenience sample of humanitarian and development workers via email listservs. Respondents were asked questions related to their professional background and experience, their use and knowledge of the UNICEF Cholera Toolkit, and their experience with the toolkit's website. Results were analyzed via Microsoft Excel.

Results: The survey was completed in 20 different countries by 32 individuals. Approximately 81% of respondents reported they were aware of the UNICEF Cholera Toolkit. Of those who were aware, 92.3% have used the toolkit in the past. Seventy-six percent of respondents said the toolkit was useful to their work. Approximately 84% of respondents indicated that they had recommended the toolkit to colleagues as a reference guide; however, 61.5% of respondents said they thought most field-based staff involved in cholera work were not aware of the toolkit. About 32% of respondents have utilized the hard copy of the toolkit and 26.7% indicated a need for additional hard copies for field staff.

Discussion: Based on the data collected from the survey, respondents view the toolkit as a legitimate guidance document and source of information for cholera. Respondents identified a desire for more practical tools and resources to be developed to complement the overall toolkit.

Table of Contents

I. CHAPTER 1 - Introduction 1

a. Background 1

II. CHAPTER 2 - Background and Review of the Literature 3

a. An overview of cholera 3

b. Epidemiology of cholera 4

c. Prevention, management, and treatment of cholera 6

d. Oral cholera vaccines 8

e. Lessons learned from past cholera outbreaks 8

f. Other resources for cholera response 10

MSF Cholera Guidelines 11

Oxfam Great Britain (GB) Cholera Outbreak Guidelines: Preparedness, Prevention and Control 11

WHO Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness 12

The Centers for Disease Control and Prevention (CDC) Cholera Resources 12

g. Similar evaluations of guidance documents completed in the past 12

III. CHAPTER 3 - Methods 15

a. Research team 15

b. Evaluation objectives 15

c. The UNICEF Cholera Toolkit overview 15

d. The UNICEF Cholera Toolkit evaluation questionnaire 16

e. Online survey platform 19

f. Sample population and recruitment strategy 19

g. Analysis of survey results 20

IV. CHAPTER 4 - Results 21

a. Respondent background information 21

b. Respondents use and familiarity with the UNICEF Cholera Toolkit 24

c. Characteristics of Respondents who were not aware of the toolkit 26

d. The toolkit format, amount of detail, and language preferences among respondents 26

e. Usefulness and usability of the UNICEF Cholera Toolkit website among respondents 28

f. Results of the free-text data 29

Respondent's feedback on how to improve the user friendliness of the toolkit 29

Usefulness of the toolkit to the respondent's work 30

Respondent's views as the most important aspects of the toolkit 31

Information respondents think should be added to any future versions of the toolkit 31

The usefulness of the appendices in the toolkit among respondents 32

Recommendations for future distribution methods among respondents 33

Recommendations on how to make the toolkit's website more useful among respondents 33

V. CHAPTER 5 - Discussion and Recommendations for Future Versions of the UNICEF Cholera Toolkit 35

a. Discussion 35

VI. CHAPTER 6 - Evaluation Limitations and Conclusion 37

a. Limitations 37

b. Conclusion 38

References 39

Appendix A: Survey Questionnaire 41

Appendix B: Recommendations to UNICEF for Future Versions of the UNICEF Cholera Toolkit 54

Format options for future versions of the toolkit 55

Dissemination strategies for future resources and toolkits 56

Changes and information to include on the toolkit website 57

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