Content validation of needs assessment survey for remote education initiative in Tanzania.

Background: Historically, educational initiatives in global health have involved expert lectures by visitors. However, incomplete understanding of the target population and resources can limit the efficacy of lectures by international faculty. Little data exists on the magnitude of this problem. The goal of this study was to create and validate a needs assessment tool to guide lecture development as part of a larger study to implement virtual lectures for a residency program in Tanzania by members of an American faculty. Methods: Two study authors familiar with the Tanzanian hospital and residency program derived surveys for local residents and faculty. An expert panel consisting of two faculty members and one resident from each institution evaluated the questions. Each item was rated from 1 to 4 for clarity and relevance respectively. A content validity index (CVI) was calculated for each item using the proportion of experts who rated it as valid. Items with a CVI < 0.8 were revised and resubmitted. A CVI was then calculated for each instrument. Results: On the initial resident survey, 20 of 26 items were clear and 25 of 26 items were relevant with a CVI > 0.8. One item was deemed irrelevant and deleted. For the faculty survey, 10 of 12 items were clear and all items were relevant with CVI > 0.8. Five questions from the resident survey and two from the faculty survey deemed relevant but unclear were rewritten and resubmitted to experts. They all achieved CVI>0.8. Each survey obtained a CVI of 1. Conclusions: Using this approach, we validated a needs assessment tool to guide the creation of didactics for audiences that practice in a different setting from the lecturer.  This validated tool is an important step in the creation of a process to develop appropriate content and could be replicated by other groups planning similar initiatives.

Implementation research on community health workers' provision of maternal and child health services in rural Liberia.

OBJECTIVE: To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. METHODS: The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. FINDINGS: Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. CONCLUSION: We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.