Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa

The Psychometric Properties of the Chinese Version of the Pain Relief Motivation Scale in Patients With Neurogenic Chronic Pain

BACKGROUND

The Pain Relief Motivation Scale (PRMS) was administered to chronic pain sufferers and predicts their psychological well-being. However, the Chinese version of the PRMS has not undergone psychometric validation.

OBJECTIVES

The PRMS will be psychometrically validated in patients with neuropathic pain-induced chronic pain from mainland China.

METHODS

This cross-sectional study involved 340 patients with neuropathic chronic pain from China. The measurability of the Chinese version of the PRMS was determined by the critical ratio between items, and reliability was confirmed by Cronbach's alpha coefficient. The study also examined the validity of the construction and criterion validity of the Chinese PRMS.

RESULTS

The Chinese version of the PRMS had critical ratio (CR) values ranging from 4.044 to 15.977 (p < 0.05). The Cronbach's alpha coefficient for the scale was 0.821, and the Cronbach's alpha coefficients for the subscales ranged from 0.663 to 0.961. Exploratory Factor Analysis (EFA) showed that five variables accounted for 77.73% of the total variance. The results of the Confirmatory Factor Analysis (CFA) supported the framework for the assessment of the 21-item PRMS. The Chinese version of the PRMS was positively correlated with the General Self-Efficacy Scale in the correlation validity analyses (r = 0.458, p < .001).

CONCLUSION

The Chinese version of the PRMS has powerful validity and reliability and can be used to assess the level of the motivation for pain alleviation in people with pain, serving as a reference for the development of intervention programs for healthcare providers.

Community health workers' quality of comprehensive care: a cross-sectional observational study across three districts in South Africa

Background

Community healthcare worker (CHW) training programs are becoming increasingly comprehensive (an expanded range of diseases). However, the CHWs that the program relies on have limited training. Since CHWs' activities occur largely during household visits, which often go unsupervised and unassessed, long-term, ongoing assessment is needed to identify gaps in CHW competency, and improve any such gaps. We observed CHWs during household visits and gave scores according to the proportion of health messages/activities provided for the health conditions encountered in households. We aimed to determine (1) messages/activities scores derived from the proportion of health messages given in the households by CHWs who provide comprehensive care in South Africa, and (2) the associated factors.

Methods

In three districts (from two provinces), we trained five fieldworkers to score the messages provided by, and activities of, 34 CHWs that we randomly selected during 376 household visits in 2018 and 2020 using a cross-sectional study designs. Multilevel models were fitted to identify factors associated with the messages/activities scores, adjusted for the clustering of observations within CHWs. The models were adjusted for fieldworkers and study facilities (n = 5, respectively) as fixed effects. CHW-related (age, education level, and phase of CHW training attended/passed) and household-related factors (household size [number of persons per household], number of conditions per household, and number of persons with a condition [hypertension, diabetes, HIV, tuberculosis TB, and cough]) were investigated.

Results

In the final model, messages/activities scores increased with each extra 5-min increase in visit duration. Messages/activities scores were lower for households with either children/babies, hypertension, diabetes, a large household size, numerous household conditions, and members with either TB or cough. Increasing household size and number of conditions, also lower the score. The messages/activities scores were not associated with any CHW characteristics, including education and training.

Conclusion

This study identifies important factors related to the messages provided by and the activities of CHWs across CHW teams. Increasing efforts are needed to ensure that CHWs who provide comprehensive care are supported given the wider range of conditions for which they provide messages/activities, especially in households with hypertension, diabetes, TB/cough, and children or babies.