Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

Evaluating the Efficacy of the Newborn Communication, Health, Feeding, and Swallowing Education Program (N-CHFSEP) for First-Time Mothers in Mangalore taluk, Dakshina Kannada district, Karnataka, India: A Preliminary Study

Background

Primiparous mothers face diverse challenges during pregnancy and post-childbirth. There is limited data on the effectiveness of postnatal educational programs for new mothers (Subramanian et al., 2020). This study aimed to assess the efficacy of an educational program designed to improve primiparous mothers' attitudes toward newborn communication, general health, feeding, and swallowing. The objectives were (1) to develop an attitude questionnaire (AQ), a parent education program [Newborn Communication, Health, Feeding and Swallowing Education Program (N-CHFSEP)], and a feedback questionnaire (FQ); and (2) to estimate the efficacy of N-CHFSEP pre- and post-delivery. The research, conducted between August 2023 and February 2024, involved 98 primiparous mothers who gave birth to healthy newborns through any delivery method. Participants were proficient in English or Kannada. The study excluded mothers delivering multiples, those with significant medical or psychological issues, and health professionals.

Methods

The study had two phases: Phase 1 developed and validated the AQ, N-CHFSEP, and FQ. N-CHFSEP covered key topics, including milestones in communication, feeding, and general health from birth to 6 months. Phase 2 administered these tools to participants. The data was analyzed using descriptive statistics, paired t-tests, and chi-square tests.

Results

93% of mothers reported increased confidence in recognizing communication, feeding, and health-related signs in their infants after completing the program. This change was statistically significant (p < 0.05). Sociodemographic factors like maternal age, education, occupation, and family type significantly influenced confidence levels. Feedback from participants highlighted the program's effectiveness in enhancing knowledge, with suggestions for improvements.

Conclusions

N-CHFSEP significantly boosted mothers' confidence in newborn care, contributing to better maternal and infant health. However, the study lacked a control group, and the effectiveness was evaluated only immediately after the program. Future research could incorporate practical demonstrations and hands-on training to further enhance the program's impact.

Assessing the impact of the Aarambh nurturing care model on the capacity & support structures for caregiver empowerment: A qualitative study

Background & objectives The provision of nurturing care during the crucial developing phase from pregnancy to three years is essential for enduring health. The Aarambh project, executed in specific districts of Central India, utilised existing Integrated Child Development Scheme (ICDS) and healthcare facilities to improve nurturing care. This study assessed the influence of loving care interventions on the skills, functionality, and support systems of anganwadi workers (AWWs) to enhance the capabilities of primary carers. Methods This qualitative study evaluated the competencies of AWWs by observing house visits and mothers' meetings in both control (Deoli, Wardha) and intervention blocks (Ralegaon, Yavatmal), Maharashtra. Comprehensive interviews were performed with AWWs, primary carers, ICDS supervisors, CDPOs, ASHAs, and parents. Results AWWs in the intervention group exhibited substantial enhancements in providing age-appropriate guidance, play, and communication activities along with effective community-based events. Interpretation & conclusions The findings of this study suggest empowerment of beneficiaries and child development through this discussed programme framework. In light of this, it is apparent that the soft skills of service providers hold paramount importance for achieving sustainable outcomes.

Effectiveness of targeted financial aid on disability welfare for the ageing population in China: A quasi-experiment study

Background

Addressing the problem of disabilities and disability deterioration is a key task for healthy ageing. Financial aid has been an effective measure for vulnerable groups, especially ageing people with disabilities. However, the effects of targeted financial aid on preventing disability deterioration remain unknown. The Chinese government launched a targeted financial aid programme aimed at people with disabilities. In this study, we investigated the causal effects of such targeted financial aid on disability deterioration prevention for elderly people with disabilities in China.

Methods

The data set used in this study included 36 640 elderly individuals with disabilities in China between 2016-19. We constructed a quasi-experiment approach and used a difference-in-differences (DID) method to examine the counterfactual differences between the treatment group in four cities that implemented such targeted financial aid in 2018 and the control group in three cities that did not adopt the policy over the study period. We employed propensity score matching (PSM) jointly with DID to mitigate selective bias. For sensitivity analysis, we conducted supplementary analyses on alternative samples, focusing on each of the treated cities respectively. Besides the main outcome, we also used fixed effect models to test the impact of such financial aid on rehabilitation access.

Results

The targeted financial aid significantly reduced the possibility of disability deterioration for elderly people with severe disabilities (0.26%; P < 0.001). Using PSM-DID models, the impact remained significant (0.33%; P < 0.001). Moreover, financial aid was significantly related to their access to rehabilitation services (12.71%; P < 0.001). Further analysis showed the heterogenous effects of targeted financial aid across individual demographic and socioeconomic factors, as well as communities with and without rehabilitation facilities.

Conclusions

Targeted financial aid had a positive impact on preventing disability deterioration among elderly individuals aged ≥65 years with severe disabilities. Moreover, rehabilitation care had a potential mediating role in the relationship between targeted financial aid and disability deterioration prevention. This study highlights the effectiveness of targeted financial aid in preventing disability deterioration and improving rehabilitation care for people with disabilities.

Barriers in reaching new-borns and infants through home visits: A qualitative study using nexus planning framework

Background

Home visitation has emerged as an effective model to provide high-quality care during pregnancy, childbirth, and post-natal period and improve the health outcomes of mother- new born dyad. This 360⁰ assessment documented the constraints faced by the community health workers (known as the Accredited Social Health Activists, ASHAs) to accomplish home visitation and deliver quality services in a poor-performing district and co-created the strategies to overcome these using a nexus planning approach.

Methods

The study was conducted in the Raisen district of Madhya Pradesh, India. The grounded theory approach was applied for data collection and analysis using in-depth interviews, and focus group discussions with stakeholders representing from health system (including the ASHAs) and the community (rural population). A key group of diverse stakeholders were convened to utilize the nexus planning five domain framework (social-cultural, educational, organizational, economic, and physical) to prioritize the challenges and co-create solutions for improving the home visitation program performance and quality. The nexus framework provides a systemic lens for evaluating the success of the ASHAs home visitation program.

Results

The societal (caste and economic discrimination), and personal (domestic responsibilities and cultural constraints of working in the village milieu) issues emerged as the key constraints for completing home visits. The programmatic gaps in imparting technical knowledge and skills, mentoring system, communication abilities, and unsatisfactory remuneration system were the other barriers to the credibility of the services. The nexus planning framework emphasized that each of the above factors/domains is intertwined and affects or depends on each other for home-based maternal and newborn care services delivered with quality through the ASHAs.

Conclusion

The home visitation program services, quality and impact can be enhanced by addressing the social-cultural, organizational, educational, economic, and physical nexus domains with concurrent efforts for skill and confidence enhancement of the ASHAs and their credibility.