Talking health: Trusted health messengers and effective ways of delivering health messages for rural mothers in Southwest Ethiopia

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Study Justification:
– Limited research has been conducted on the perceptions of communities regarding credible messengers and messaging in rural Ethiopia.
– Access to trusted health information is crucial for improving maternal and child health outcomes.
– Understanding the sources of trusted maternal health information and preferences for the mode of delivery of health information can inform safe motherhood implementation research project interventions.
Study Highlights:
– Health Extension Workers (HEWs) and Health Development Army (HDA) were identified as trusted health messengers.
– Participants favored face-to-face/interpersonal communication channels, followed by mass media and traditional approaches like community conversation, traditional songs, and role play.
– The HEW home-to-home outreach program for health communication helped build trusting relationships with community members.
– The government should strengthen the existing health extension packages by providing in-service and refresher training to HEWs.
Study Recommendations:
– Strengthen the existing health extension packages by providing in-service and refresher training to HEWs.
– Support the HEW home-to-home outreach program for health communication.
– Utilize face-to-face/interpersonal communication channels as the primary mode of delivering health messages.
– Incorporate mass media and traditional approaches like community conversation, traditional songs, and role play in health messaging.
Key Role Players:
– Health Extension Workers (HEWs)
– Health Development Army (HDA)
– Government officials
– Community leaders
– Religious leaders
Cost Items for Planning Recommendations:
– In-service and refresher training for HEWs
– Support for the HEW home-to-home outreach program
– Development and production of health communication materials
– Mass media campaigns
– Training for community leaders and religious leaders in health messaging

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is strong, but there are some areas for improvement. The study conducted qualitative research using focus group discussions and in-depth interviews, which are appropriate methods for exploring perceptions and preferences. The data analysis was conducted using Atlas.ti software, which is a commonly used tool for qualitative analysis. The researchers also took steps to enhance credibility, transferability, confirmability, and dependability of the study. However, the abstract could be improved by providing more specific details about the sample size and characteristics of the participants, as well as the key findings of the study. Additionally, it would be helpful to include information about any limitations or potential biases in the study design or data collection process.

Summary: Background: Access to trusted health information has contribution to improve maternal and child health outcomes. However, limited research to date has explored the perceptions of communities regarding credible messenger and messaging in rural Ethiopia. Therefore, this study aimed to explore sources of trusted maternal health information and preferences for the mode of delivery of health information in Jimma Zone, Ethiopia; to inform safe motherhood implementation research project interventions. Method: An exploratory qualitative study was conducted in three districts of Jimma Zone, southwest of Ethiopia, in 2016. Twelve focus group discussions (FGDs) and twenty-four in-depth interviews (IDIs) were conducted among purposively selected study participants. FGDs and IDIs were conducted in the local language, and digital voice recordings were transcribed into English. All transcripts were read comprehensively, and a code book was developed to guide thematic analysis. Data were analyzed using Atlas.7.0.71 software. Result: Study Participants identified as Health Extension Workers (HEWs) and Health Development Army (HDA) as trusted health messengers. Regarding communication channels, participants primarily favored face-to-face/interpersonal communication channels, followed by mass media and traditional approaches like community conversation, traditional songs and role play. In particular, the HEW home-to-home outreach program for health communication helped them to build trusting relationships with community members; However, HEWs felt the program was not adequately supported by the government. Conclusion: Health knowledge transfer success depends on trusted messengers and adaptable modes. The findings of this study suggest that HEWs are a credible messenger for health messaging in rural Ethiopia, especially when using an interpersonal message delivery approach. Therefore, government initiatives should strengthen the existing health extension packages by providing in-service and refresher training to health extension workers.

The study was conducted in Jimma Zone, located in the southwest region of Ethiopia. Jimma town is 346 km from Addis Ababa, the capital of Ethiopia. The Zone is known for its production of “Coffee Arabica” which is the back bone of the country’s economy. Jimma town has located a latitude and longitude of 7°40′N 36°50′E. Jimma Zone has 21 districts. Among these, three districts were purposively selected for this project (Gomma, Seka Chekorsa and Kersa) by considering of high population size and low health service utilization. The number of health centers, health posts, HEWs and Health development army leaders in the selected three districts were 28, 110,231 and 3384 respectively [8]. The study was conducted in May and June 2016. This research used an exploratory qualitative case study to better understand participants’ understanding of trusted maternal health information sources and their preferred communication channels. For purposes of this study, trusted messengers were defined as persons regarded by community members as credible sources of health information for pregnant women in making informed decisions regarding health maintenance and health seeking behavior. Preferred communication channels described the different means or venues in which community members liked to receive IEC messaging. These preferences were assessed by in-depth interviews (IDI) and focus group discussion (FGDs). The FGDs and IDIs were considered to create an appropriate context for the researchers to explore community member feelings, perceptions, and understanding of the maternal/child health (MCH) topics that would form part of the IEC intervention. Data collection involved IDI and FGDs. Six individual depth-interview were conducted for each of the following stakeholder groups: religious leaders, health extension workers (HEWs), and members of the Women Development Army (WDA) and Male Development Army (MDA)1(total N = 24). Six FGDs were held among female community members and another six with male community members (see Appendices 1–6 for a detailed sampling overview). Researchers developed IDI and FGD guides based on a review of literatures in the areas of health communication, message development, and message delivery approaches, with a focus on improving maternal and child health outcomes associated with pregnancy and childbirth [9–11]. These instruments were tailored to explore the different experiences, perceptions, and roles of each group of study participants (HEW, WDA, MDA, religious leaders, male community members, and female community members). Each guide contains questions on basic socio-demographic variables like age, sex, educational status and role in the community, as well as questions and probes on existing and preferred IEC programs related to improving MCH outcomes in rural contexts. Written and/or oral consent was obtained from all participants. IDIs and FGDs were conducted in convenient, quiet and private locations in order to ensure confidentiality. Data were collected using digital audio recorders and field note memos were taken to document non-verbal or other behaviors observed during the data collection. Audiotapes and notes were transcribed following data collection. Atlas.ti 7.0.71 software was used for data analysis. A rough outline of thematic categories was drafted based on the themes that were specified in the FGDs and IDI guidelines. This outline was further developed into a preliminary code guide. Next, all FGD and IDI transcripts were read multiple times by the research team to produce a final code guide. To enhance inter-coder reliability, the coders independently applied the guide to all transcripts; discrepancies were reviewed and resolved. This exercise ensured that the coders had a common understanding of the code guide and its application. Exemplary quotations for selected codes were generated in Atlas.ti software using the Code Manager/Output feature. The summaries presented below reflect both widely-expressed ideas, as well as novel ideas that were mentioned less frequently. To promote credibility, data collection tools were pretested in similar contexts to maximize the validity of the tool. The IDI and FGD questions were open-ended and participants were encouraged to discuss the questions in an uninhibited manner while being guided to remain focused on the topic of interest. To promote transferability, appropriate probes were used to obtain detailed information on responses. Detailed field notes were taken, and all interviews were digitally recorded (thick description). To address confirmability, this study employed reflectivity and bracketing methods. These methods helped to minimize respondent bias and the risk of reactivity whereby participants could deny information due to the presence of data collectors and researcher, while “bracketing out” daily debriefing sessions provided an opportunity for the data collectors and researchers to explore how their own preconceived ideas might be affecting the study, and to increase their reflexivity in later interpreting the findings. To promote dependability, all data collectors were bilingual (fluent in both English and the local languages) and trained at the post-graduate level. They also had prior experience in qualitative data collection, and had participated in an intensive, week-long training program prior to undertaking field research. Interviews were conducted until data saturation was reached, within the limits imposed by geography and time-frame for the study. The duration of the interviews and discussions ranged from 45 to 90 min (prolonged engagement).

Based on the information provided, here are some potential innovations that could improve access to maternal health in rural Ethiopia:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide trusted maternal health information to rural mothers. These apps could include features such as pregnancy tracking, health tips, and reminders for prenatal care appointments.

2. Community Health Workers: Train and empower community health workers, such as Health Extension Workers (HEWs) and Health Development Army (HDA) leaders, to serve as trusted messengers for maternal health information. Provide them with additional training and resources to effectively communicate with and educate rural mothers.

3. Interpersonal Communication: Strengthen and expand the HEW home-to-home outreach program for health communication. This approach allows for personalized and face-to-face interactions between health workers and community members, building trust and facilitating the exchange of health information.

4. Mass Media Campaigns: Utilize mass media channels, such as radio and television, to disseminate maternal health messages to a wider audience. Develop culturally appropriate content and use local languages to ensure maximum reach and understanding.

5. Traditional Approaches: Incorporate traditional approaches, such as community conversations, traditional songs, and role play, into maternal health messaging. These methods can engage and resonate with rural communities, making the information more relatable and memorable.

6. Government Support: Advocate for increased government support for the existing health extension packages, including providing in-service and refresher training to health extension workers. This will enhance their knowledge and skills in delivering maternal health information effectively.

These innovations aim to improve access to trusted maternal health information and enhance communication channels in rural Ethiopia, ultimately contributing to better maternal and child health outcomes.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health is to strengthen the existing health extension packages by providing in-service and refresher training to health extension workers (HEWs). This recommendation is based on the findings of the study conducted in Jimma Zone, Ethiopia, which identified HEWs as trusted health messengers for maternal health information in rural communities.

The study found that HEWs, through their home-to-home outreach program, were able to build trusting relationships with community members. However, the HEWs felt that the program was not adequately supported by the government. Therefore, the recommendation is to provide in-service and refresher training to HEWs to enhance their knowledge and skills in delivering maternal health messages effectively.

By strengthening the capacity of HEWs, they can serve as credible messengers for health messaging in rural Ethiopia. This can be achieved by equipping them with up-to-date information, communication skills, and strategies for effective message delivery. Additionally, providing ongoing support and supervision to HEWs can help ensure the quality and consistency of their health communication efforts.

Overall, the recommendation to provide in-service and refresher training to HEWs is an innovative approach to improving access to maternal health in rural Ethiopia. By investing in the training and support of trusted messengers, the government can enhance the delivery of health messages and ultimately improve maternal and child health outcomes.
AI Innovations Methodology
Based on the provided information, the study aimed to explore sources of trusted maternal health information and preferences for the mode of delivery of health information in rural Ethiopia, specifically in Jimma Zone. The study identified Health Extension Workers (HEWs) and Health Development Army (HDA) as trusted health messengers. Participants favored face-to-face/interpersonal communication channels, followed by mass media and traditional approaches like community conversation, traditional songs, and role play.

To simulate the impact of recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the recommendations: Based on the study findings, identify specific recommendations that can improve access to maternal health. For example, one recommendation could be to strengthen the existing health extension packages by providing in-service and refresher training to health extension workers.

2. Identify key indicators: Determine the key indicators that can measure the impact of the recommendations on improving access to maternal health. This could include indicators such as the number of women accessing maternal health services, the reduction in maternal mortality rates, or the increase in knowledge and awareness about maternal health.

3. Collect baseline data: Gather baseline data on the identified indicators before implementing the recommendations. This will provide a benchmark against which the impact of the recommendations can be measured.

4. Implement the recommendations: Put the recommendations into action by providing the necessary training and support to health extension workers. Monitor the implementation process to ensure adherence to the recommendations.

5. Collect post-implementation data: After a certain period of time, collect data on the same indicators to measure the impact of the recommendations. This data will help determine whether the recommendations have led to improvements in access to maternal health.

6. Analyze the data: Use statistical analysis techniques to compare the baseline and post-implementation data. This will allow for a quantitative assessment of the impact of the recommendations on improving access to maternal health.

7. Interpret the results: Based on the analysis, interpret the results to determine the effectiveness of the recommendations. This will help identify any gaps or areas for improvement in the implementation process.

8. Make adjustments if necessary: If the results indicate that the recommendations have not led to the desired improvements, make necessary adjustments to the implementation strategy. This could involve revising the training programs or exploring alternative communication channels.

9. Continuously monitor and evaluate: Implementing a system for continuous monitoring and evaluation will ensure that the impact of the recommendations is sustained over time. Regularly collect data and assess the progress made in improving access to maternal health.

By following this methodology, it will be possible to simulate the impact of recommendations on improving access to maternal health and make informed decisions on how to effectively implement and scale up interventions in rural Ethiopia.

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