SEARCHRCTpublic health, nutrition

RCT·public health, nutrition, pediatrics, epidemiology, clinical trial·PMC10012630

Assessing sustainment of health worker outcomes beyond program end: Evaluation results from an infant and young child feeding intervention in Bangladesh

Frontiers in Health Services · 11 authors, 9 centres

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TL;DR

This cluster-randomized controlled trial assessed health worker outcomes three years after an infant and young child feeding program ended in Bangladesh. While program knowledge gains were sustained, the improvement in service delivery was not.

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This study evaluated the sustainment of a cluster-randomized infant and young child feeding (IYCF) intervention for health workers in Bangladesh. The primary outcome was the number of IYCF topics discussed during counseling. At endline, intervention workers discussed significantly more topics (4.9 vs. Job satisfaction and job readiness improved during the program but returned to levels similar to comparison areas by post-endline. Comprehensive refresher trainings were identified as a protective factor against the deterioration of service delivery. The study's limitations include potential imbalance between groups at later surveys. Findings suggest that while knowledge improvements can last, they may not be sufficient to sustain behavioral changes in service delivery without ongoing support.

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RCT

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public health

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ORIGINAL PAPER

PMC10012630

Assessing sustainment of health worker outcomes beyond program end: Evaluation results from an infant and young child feeding intervention in Bangladesh

Frontiers in Health Services

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ABSTRACT

Introduction Alive and Thrive (A&T) implemented infant and young child feeding (IYCF) interventions in Bangladesh. We examine the sustained impacts on health workers' IYCF knowledge, service delivery, job satisfaction, and job readiness three years after the program's conclusion. Methods We use data from a cluster-randomized controlled trial design, including repeated cross-sectional surveys with health workers in 2010 (baseline, n = 290), 2014 (endline, n = 511) and 2017 (post-endline, n = 600). Health workers in 10 sub-districts were trained and incentivized to deliver intensified IYCF counseling, and participated in social mobilization activities, while health workers in 10 comparison sub-districts delivered standard counseling activities. Accompanying mass media and policy change activities occurred at the national level. The primary outcome is quality of IYCF service delivery (number of IYCF messages reportedly communicated during counseling); intermediate outcomes are IYCF knowledge, job satisfaction, and job readiness. We also assess the role of hypothesized modifiers of program sustainment, i.e. activities of the program: comprehensiveness of refresher trainings and receipt of financial incentives. Multivariable difference-in-difference linear regression models, including worker characteristic covariates and adjusted for clustering at the survey sampling level, are used to compare differences between groups (intervention vs. comparison areas) and over time (baseline, endline, post-endline). Results At endline, health workers in intervention areas discussed significantly more IYCF topics than those in comparison areas (4.9 vs. 4.0 topics, p < 0.001), but levels decreased and the post-endline gap was no longer significant (4.0 vs. 3.3 topics, p = 0.067). Comprehensive refresher trainings were protective against deterioration in service delivery. Between baseline and endline, the intervention increased health workers' knowledge (3.5-point increase in knowledge scores in intervention areas, vs. 1.5-point increase in comparison areas, p < 0.0001); and this improvement persisted to post-endline, suggesting a sustained program effect on knowledge. Job satisfaction and readiness both saw improvements among workers in intervention areas during the project period (baseline to endline) but regressed to a similar level as comparison areas by post-endline. Discussion Our study showed sustained impact of IYCF interventions on health workers' knowledge, but not job satisfaction or job readiness—and, critically, no sustained program effect on service delivery. Programs of limited duration may seek to assess the status of and invest in protective factors identified in this study (e.g., refresher trainings) to encourage sustained impact of improved service delivery. Studies should also prioritize collecting post-endline data to empirically test and refine concepts of sustainment.

CITATION EXPORT

Corrina Moucheraud, Adrienne Epstein, Haribondhu Sarma et al.. Assessing sustainment of health worker outcomes beyond program end: Evaluation results from an infant and young child feeding intervention in Bangladesh. Frontiers in Health Services. (2023). https://doi.org/10.3389/frhs.2022.1005986

AUTHORS

11 · 9 CENTRES

Corrina Moucheraud, Adrienne Epstein, Haribondhu Sarma, Sunny S. Kim, Phuong Hong Nguyen, Mahfuzur Rahman, Md. Tariquijaman, Jeffrey Glenn, Denise D. Payán, Purnima Menon, Thomas J. Bossert

1Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
2Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
4International Food Policy Research Institute, Washington, DC, United States
5International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
6Department of Public Health, Brigham Young University, Provo, UT, United States
7Department of Health, Society, and Behavior, University of California, Irvine, CA, United States
8International Food Policy Research Institute, New Delhi, India
9School of Public Health, Harvard University, Boston, MA, United States