Measuring client trust in community health workers: A multi-country validation study
| Autor: | Timothy Abuya, Ann Gottert, Sharif M.I. Hossain, Alain Casseus, Tracy L McClair, Pooja Sripad |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
030231 tropical medicine
Applied psychology Context (language use) Trust 03 medical and health sciences 0302 clinical medicine Pregnancy Health care Content validity Humans 030212 general & internal medicine Qualitative Research Community Health Workers business.industry Health Policy Public Health Environmental and Occupational Health Reproducibility of Results Focus Groups Focus group Confirmatory factor analysis Convergent validity Scale (social sciences) Community health Female business Psychology Research Theme 3: Community Health Initiatives |
| Zdroj: | Journal of Global Health |
| ISSN: | 2047-2986 2047-2978 |
| Popis: | Background Client trust in community health workers (CHWs) is integral for improving quality and equity of community health systems globally. Despite its recognized conceptual and pragmatic importance across health areas, there are no quantitative measures of trust in the context of community health services. In this multi-country study, we aimed to develop and validate a scale that assesses trust in CHWs. Methods To develop the scale, we used a consultative process to conceptualize and adapt items and domains from prior literature to the CHW context. Content validity and comprehension of scale items were validated through 10 focus group discussions with 75 community members in Haiti, and Kenya. We then conducted 1939 surveys with clients who interacted with CHWs recently in Bangladesh (n = 1017), Haiti (n = 616), and Kenya (n = 306). To analyze the 15 candidate scale items we conducted a split sample exploratory/confirmatory factor analysis (EFA/CFA), and then assessed internal consistency reliability of resulting set of items. Finally, we assessed convergent validity via multivariable models examining associations between final scale scores with theoretically related constructs. Results Factor analyses resulted in a 10-item Trust in CHWs Scale with two factors (sub-scales): Health care competence (5 items) and Respectful communication (5 items). The qualitative data also underscored these two sub-domains. The full scale had good internal consistency reliability in Bangladesh, Haiti and Kenya (alphas 0.87, 0.86, and 0.92, respectively; all alphas for subscales were also > 0.7, most > 0.8). Greater scores on Trust in CHWs were positively associated with increased client empowerment, familiarity with CHWs, satisfaction with recent client-CHW interaction, and positive influence of CHW on client empowerment. Scale scores were not influenced by the age, sex, parity, education, and wealth quintiles in across countries and may be affected by contextual factors. Conclusions The Trust in CHWs Scale, which includes Health care competence and Respectful communication sub-scales, is the first such scale developed and validated globally. Our findings suggest this 10-item scale is a reliable and valid tool for quantifying clients' trust in CHWs, with potential utility for tracking and improving CHW and health systems performance over time. |
| Databáze: | OpenAIRE |
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