Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh

• Main Authors: Tania Jahir, Peter J. Winch, Elli Leontsini, Sharon T. Hwang, Farzana Yeasmin, Khobair Hossain, Jyoti Bhushan Das, Ruhul Amin, Tarique Md. Nurul Huda, Jesmin Sultana, Rizwana Khan, Fahmida Akter, AKM Shoab, Rezaul Hasan, Helen O. Pitchik, Fahmida Tofail, Lia C. H. Fernald, Stephen P. Luby, Mahbubur Rahman
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: community health workers; integrated intervention; group sessions; early child development; maternal mental health; prevention of lead exposure
• Online Access: https://www.mdpi.com/1660-4601/18/15/7891

Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.