Community Health Worker PerformanceNCT03684551
Improving Community Health Worker Performance With a Supervision Dashboard
A study testing The CHW-led health system, The CHW Supervision model and The CHW Performance Dashboard in people with Community Health Worker Performance, run by Ari Johnson, MD.
Trial summary
Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. Read more about this study
- Who is it for?
- Ages 18 to 45 yearsHealthy volunteers can take part
- Conditions the study is for
- Community Health Worker Performance
- What is being tested?
- The CHW-led health system, The CHW Supervision model and The CHW Performance Dashboard
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 148 participants
- Where
- No sites listed yet
- Study dates
- 1 Nov 2015to 31 Oct 2016
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- To be a CHW in the study site at the time of enrolment (n=148)
Who cannot join
- CHW who pretested the Dashboard tool (n=2)
About this study
Official title: Improving Community Health Worker Performance by Using a Personalised Feedback Dashboard for Supervision: a Randomised Controlled Trial
Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. This randomised controlled trial aims to determine the effect of a personalised performance dashboard used as a supervision tool on the quantity, speed, and quality of CHW care. This study is a randomised controlled trial in a large health catchment area in peri-urban Mali. One hundred forty-eight CHWs conducting proactive case-finding home visits were randomly allocated to receive individual monthly supervision with or without the CHW Performance Dashboard from January to June 2016. Randomisation was stratified by CHW supervisor, level of CHW experience, and CHW baseline performance for monthly quantity of care (number of household visits). With regression analysis, we used a difference-in-difference model to estimate the effect of the intervention on monthly quantity, timeliness (percentage of children under five treated within 24 hours of symptom onset), and quality (percentage of children under five treated without protocol error) of care over a six-month post-intervention period relative to a three-month pre-intervention period.
- Conditions
- Community Health Worker Performance
- Being tested
- The CHW-led health system, The CHW Supervision model, The CHW Performance Dashboard
- Keywords
- Community Health Worker, Health worker supervision, Mali, Randomized controlled trial
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
The CHW-led health systemOther
During the study period, all CHWs, regardless of treatment arm, performed proactive case detection, the process of conducting at least two hours per day of door-to-door home visits to proactively identify - through health history inquiry and/or disease diagnostics - patients who need care. For all patients identified, CHWs provided doorstep counselling, evaluation, diagnostics, treatment, referral to appropriate health facilities, and follow-up. CHWs provided care in the community without user fees, and were able to refer patients to the reinforced government primary health centres for care without user fees as well. CHWs were residents of the communities they served, and they were required to be available at home or by phone for consultation at any time.
The CHW Supervision modelOther
CHWs in both study arms received monthly individual supervisory sessions and weekly group supervisory sessions from their dedicated CHW supervisor. An individual monthly session of 360 Supervision included: (i) solicitation of patient perspectives of CHW care; (ii) direct observation of CHW doorstep care; and (iii) a one-on-one feedback discussion with or without the CHW Performance Dashboard depending on treatment arm.
The CHW Performance DashboardOther
The CHW Performance Dashboard was a graphic display of a CHW's performance along three indicators defined as follows: (i) "Quantity" of care: the number of homes visited during the month; (ii) "Timeliness" of care: the percentage of sick children under five treated within 24 hours of symptom onset during the month; (iii) "Quality" of care: the percentage of sick children under five treated without protocol error among 23 potential errors during the month. The Dashboard displayed an individual CHW's quantity, timeliness, and quality of care indicators from the previous month, using absolute numbers, percentages, and visual graphics, alongside those of the highest performing CHW. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month.
| Study group | Role | What they receive |
|---|---|---|
| No dashboard supervision tool | Active comparator | CHWs received monthly individual supervision from a dedicated CHW supervisor. The supervisory feedback session for CHWs in the control arm was not facilitated by a visual Dashboard tool or any personalised quantitative feedback on quantity, speed, or quality of care. CHW supervisors were instructed to continue providing CHWs in the control arm with feedback informed by patient perspectives and direct observation during the individual supervision visit. Receives: Other: The CHW-led health system; Other: The CHW Supervision model |
| Dashboard supervision tool | Experimental | CHWs received monthly individual supervision from a dedicated CHW supervisor. For CHWs randomised to the intervention arm, a visual feedback tool, the CHW Performance Dashboard, was employed during individual supervision, starting in January 2016. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month. The feedback provided to CHWs in the intervention arm, therefore, was both quantitative, informed by the Dashboard, and qualitative, informed by patient perspectives and direct observation of CHW service provision during the individual supervision visit. Receives: Other: The CHW-led health system; Other: The CHW Supervision model; Other: The CHW Performance Dashboard |
What is being measured
The primary outcome is the main question the study is designed to answer.
Quantity of care
The number of proactive case-finding home visits during the month
Measured: 9 months
Secondary outcomes (2)
Timeliness of care
The percentage of sick children under five treated within 24 hours of symptom onset during the month
Measured: 9 months
Quality of care
The percentage of sick children under five treated without protocol error among 23 potential errors during the month
Measured: 9 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Sep 2018
- Study start1 Nov 2015
- Primary completion30 Jun 2016
- Study completion31 Oct 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Community Health Worker PerformanceStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 148 participants (actual)
Sponsor and investigators
- Lead sponsor
- Ari Johnson, MD
- Sponsor type
- University, hospital or other
- Collaborators
- Muso, Bamako Mali and San Francisco USA, Malaria Research and Training Center, Bamako, Mali, University of California, San Francisco, Harvard Medical School (HMS and HSDM), Medic Mobile, San Francisco, USA, Malian Ministry of Health and Public Hygiene
- Responsible party
- Sponsor-investigator, Ari Johnson, MD, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03684551
- Sponsor's protocol ID
- 1015-0616
- Status last verified
- Sep 2018
- First submitted
- 14 Sep 2018
- Last updated
- 25 Sep 2018
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Whidden C, Kayentao K, Liu JX, Lee S, Keita Y, Diakite D, Keita A, Diarra S, Edwards J, Yembrick A, Holeman I, Samake S, Plea B, Coumare M, Johnson AD. Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial. J Glob Health. 2018 Dec;8(2):020418. doi: 10.7189/jogh.08.020418.
PubMed 30333922
Study at a glance
From the registry record, last updated by the sponsor on 25 Sep 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Improving Community Health Worker Performance by Using a Personalised Feedback Dashboard for Supervision: a Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT03684551
- Acronym / sponsor ID
- 1015-0616
- Conditions
- Community Health Worker Performance
- Keywords
- Community Health Worker, Health worker supervision, Mali, Randomized controlled trial
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 148 participants (actual)
- Lead sponsor
- Ari Johnson, MDUniversity, hospital or other
- Collaborators
- Muso, Bamako Mali and San Francisco USA, Malaria Research and Training Center, Bamako, Mali, University of California, San Francisco, Harvard Medical School (HMS and HSDM), Medic Mobile, San Francisco, USA, Malian Ministry of Health and Public Hygiene
- Study start
- 1 Nov 2015 (actual)
- Primary completion
- 30 Jun 2016 (actual)
- Study completion
- 31 Oct 2016 (actual)
- First posted
- 25 Sep 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. This randomised controlled trial aims to determine the effect of a personalised performance dashboard used as a supervision tool on the quantity, speed, and quality of CHW care. This study is a randomised controlled trial in a large health catchment area in peri-urban Mali. One hundred forty-eight CHWs conducting proactive case-finding home visits were randomly allocated to receive individual monthly supervision with or without the CHW Performance Dashboard from January to June 2016. Randomisation was stratified by CHW supervisor, level of CHW experience, and CHW baseline performance for monthly quantity of care (number of household visits). With regression analysis, we used a difference-in-difference model to estimate the effect of the intervention on monthly quantity, timeliness (percentage of children under five treated within 24 hours of symptom onset), and quality (percentage of children under five treated without protocol error) of care over a six-month post-intervention period relative to a three-month pre-intervention period.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| No dashboard supervision tool | Active comparator | Other: The CHW-led health system, Other: The CHW Supervision modelCHWs received monthly individual supervision from a dedicated CHW supervisor. The supervisory feedback session for CHWs in the control arm was not facilitated by a visual Dashboard tool or any personalised quantitative feedback on quantity, speed, or quality of care. CHW supervisors were instructed to continue providing CHWs in the control arm with feedback informed by patient perspectives and direct observation during the individual supervision visit. |
| Dashboard supervision tool | Experimental | Other: The CHW-led health system, Other: The CHW Supervision model, Other: The CHW Performance DashboardCHWs received monthly individual supervision from a dedicated CHW supervisor. For CHWs randomised to the intervention arm, a visual feedback tool, the CHW Performance Dashboard, was employed during individual supervision, starting in January 2016. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month. The feedback provided to CHWs in the intervention arm, therefore, was both quantitative, informed by the Dashboard, and qualitative, informed by patient perspectives and direct observation of CHW service provision during the individual supervision visit. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- To be a CHW in the study site at the time of enrolment (n=148)
Key exclusion criteria (1 listed)
- CHW who pretested the Dashboard tool (n=2)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| The CHW-led health systemDuring the study period, all CHWs, regardless of treatment arm, performed proactive case detection, the process of conducting at least two hours per day of door-to-door home visits to proactively identify - through health history inquiry and/or disease diagnostics - patients who need care. For all patients identified, CHWs provided doorstep counselling, evaluation, diagnostics, treatment, referral to appropriate health facilities, and follow-up. CHWs provided care in the community without user fees, and were able to refer patients to the reinforced government primary health centres for care without user fees as well. CHWs were residents of the communities they served, and they were required to be available at home or by phone for consultation at any time. | Other | Dashboard supervision tool, No dashboard supervision tool |
| The CHW Supervision modelCHWs in both study arms received monthly individual supervisory sessions and weekly group supervisory sessions from their dedicated CHW supervisor. An individual monthly session of 360 Supervision included: (i) solicitation of patient perspectives of CHW care; (ii) direct observation of CHW doorstep care; and (iii) a one-on-one feedback discussion with or without the CHW Performance Dashboard depending on treatment arm. | Other | Dashboard supervision tool, No dashboard supervision tool |
| The CHW Performance DashboardThe CHW Performance Dashboard was a graphic display of a CHW's performance along three indicators defined as follows: (i) "Quantity" of care: the number of homes visited during the month; (ii) "Timeliness" of care: the percentage of sick children under five treated within 24 hours of symptom onset during the month; (iii) "Quality" of care: the percentage of sick children under five treated without protocol error among 23 potential errors during the month. The Dashboard displayed an individual CHW's quantity, timeliness, and quality of care indicators from the previous month, using absolute numbers, percentages, and visual graphics, alongside those of the highest performing CHW. During the individual supervisory feedback session, this personalised and relative (to the highest performer) quantitative performance feedback helped orient the discussion of strengths and weaknesses, and allowed the CHW to see quantitatively and visually how his/her performance fared the previous month. | Other | Dashboard supervision tool |
Primary outcome
Quantity of care
Time frame: 9 months
The number of proactive case-finding home visits during the month
2 secondary outcomes
Timeliness of care
Time frame: 9 months
Quality of care
Time frame: 9 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Sep 2018.
- Derived from this study: PubMed 30333922Whidden C, Kayentao K, Liu JX, Lee S, Keita Y, Diakite D, Keita A, Diarra S, Edwards J, Yembrick A, Holeman I, Samake S, Plea B, Coumare M, Johnson AD. Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial. J Glob Health. 2018 Dec;8(2):020418. doi: 10.7189/jogh.08.020418.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing The CHW-led health system, The CHW Supervision model and The CHW Performance Dashboard in people with Community Health Worker Performance, run by Ari Johnson, MD.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 25 Sep 2018. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Quantity of care (time frame: 9 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03684551, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Sep 2018.