A qualitative process evaluation of maternal and baby WASH and nutrition project using a Care Group approach in western Kenya Open Access
Linabarger, Molly (Spring 2018)
Abstract
Nearly 6 million children under the age of 5 die each year and many of these deaths could be prevented by low-cost or no-cost behaviors. Interventions to improve health practices have been found to have varying levels of effectiveness in short- and long-term behavior change and maintenance. One commonly used approach designed to stimulate long-term behavior change is the Care Group model. By training local volunteers to facilitate behavior change among neighbors, the Care Group model creates a multiplying effect allowing messages to reach more households than a traditional community health worker. As the use of the Care Group model increases, understanding factors that affect its implementation can improve delivery of behavior change messages to project beneficiaries. However, few studies have been done to determine what level of fidelity projects using the Care Group model have to their intended delivery. We conducted a qualitative, theoretically-driven, cross-sectional process evaluation of an intervention that used a Care Group model in western Kenya to examine the fidelity, dose delivered, dose received, and context of the project through project document review, in-depth interviews, and observations. Communication of messages did not follow the intended timeline or order. Topics delivered did not match the work plan. All observed meetings missed some messages and many did not include specific behavior change components. Meetings and home visits were shorter than designed. Some care group volunteers were perceived by project staff to have poor facilitation skills. The implementation of the project was affected by low acceptability of a messages-only approach. Project staff and volunteers made some adaptations to the local context. Proper training, tools, and a thorough monitoring plan are recommendations for projects using the Care Group model. The applicability of the project in areas with intervention burnout should be determined before implementation at scale.
Table of Contents
Table of contents
CHAPTER I: Introduction ……………………………………………………………………..1
CHAPTER II: Manuscript ……………………………………………………………………..5
Contribution of the student…………………………...……………………………………….5
Title page…………………………………………………...………………………………….6
Abstract…………………………………………………...……………………………...…….7
Introduction……………………………………………………………………………………8
Methods………………………………………………………………………………………11
Intervention and setting…………………………………………………………………………….11
Data collection……………………………………………………………………………………….14
Data analysis…………………………………………………………………………………………16
Ethical approval……………………………………………………………………………………...17
Results………………………………………………………………………………………..17
Fidelity…………………………………………………………………………………………….......17
Dose delivered………………………………………………………………………………………..21
Dose received………………………………………………………………………………………....22
Context…………………………………………………………………………………………………25
Discussion…………………...……………………………………………………………….29
Acknowledgements………………………………………………...…………………………33
CHAPTER III: References ……………………………………………………………………34
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