COMPETENCE ASSESSMENT TOOL

(CAT) FOR HEALTH EDUCATORS

Saeed Anwar

Problem Statement

Health education - central to preventive and promotive health services in primary care

Health education is globally a component of Primary Healthcare 1

When talking of health educators, HE is their exclusive job role

HE sessions in our setting are as a rule going un -assessed and un – monitored or in a poorly monitored form

Magnitude of the problem

Recent statistics on a few relevant health indicators are cited below:

1. Under five mortality: 100/1000 live births

2. IMR: 76/1000 live births

3. Child immunization: 70%

4. Exclusive breastfeeding: 45%

5. MMR: 320/100 000 live births

6. CPR: 38%

7. Skilled birth attendance: 42%

8. Antenatal care: 47% 2

HFs and schools are the usual community based venues of HE

HE mostly happens as a group activity

Target audiences are often poor, rural people mostly illiterate or with low literacy level

Priority themes/subthemes of HE

1. Birth spacing

2. Regular antenatal check up and skilled birth attendance

3. Danger signs of pregnancy

4. Diet during pregnancy and lactation

5. Breastfeeding and weaning

6. Immunization

7. Growth Monitoring up to first 3 years of life

8. ORS use during diarrhea 3

*UNICEF’s Facts for Life will be used as reference for Issue Specific Key Messages

Context

Workplace based assessment of HE sessions with the help of this assessment tool

Public & private sector static community clinics in flood affected districts (Charsadda and Nowshera)

Plus point is that CHS itself got four static clinics in flood affected districts including these districts (they may serve as control)

Uses

Workplace based assessment of various cadre community educators, including lady health workers

Formative and summative assessment of medical students:

1. As workplace based assessment in community

2. On practical stations, and

3. Mini CEX

Questions in the mind?

What are the priority competencies for a health educator?

Is there any pre - existing tool to measure those?

If not, what about developing an indigenous one? And

Pilot test it for reliability assessment and validation

Literature Search

Search done for HE skills, competencies and assessment formats

List of skills returned on search included:

1. Cultural competency skills

2. Communication and interpersonal skills

3. Negotiation/Refusal skills

4. Cooperation and teamwork skills

5. Advocacy skills

6. Critical thinking skills

7. Decision making skills

8. Problem solving skills, and

9. Coping and self management skills 4

Search ---

Assessment format was found on communication for training

No format was found for the target HE skills

However there were:

1. Guidelines to assess cultural competence of organizations

2. Standards to evaluate organizational competence for health promotion

3. Standard formats of IEC material, and

4. Check lists for patient education in clinical setting

Scope of the tool

Its doesn’t claim comprehensive assessment of all the HE competencies/skills at all

Its focus is on assessing HE skills necessary for effective conduction of community based HE sessions

These include:

1. Time management skills

2. Organizational skills

3. Cultural skills, and

4. Communication skills to effectively get across the issue specific key messages to community groups

Type of scale

7 Items adjectival rating scale

Rating scaleSKILL ITEMS

Cultural skills 1. Session takes care of socio - cultural norms

2. People are greeted in culturally appropriate way

3. Session breaks for prayer well in time (skip if NA)

Time management skills 4. Session duration is shared at start

5. Session closes on time

Organizational skills 6. Overall organization for the session is appropriate

7. Support material is at hand

8. Support material is pre deployed at right place(s)

Communication skills 9. Introduces self appropriately

10. Shares purpose of the session

11. Maintains eye contact with the group

12. Non verbal cues match the verbal communication

13. Explains technical term(s) in easy language (skip if NA)

Scale ---SKILL Item

Communication skills 14. Communicates in an easy lay language

15. Remains on theme largely

16. Don’t prolong unnecessarily

17. Appropriately delivers key messages on the issue

18. Takes help of the support material appropriately

19. All the key messages are delivered appropriately

20. Demonstrates the procedure appropriately (skip if NA)

21. Takes feedback on key messages appropriately

22. Takes proper feedback of the procedure (skip if NA)

23. Encourages to ask questions

24. Responds to questions appropriately

25. Clarifies appropriately where needed (skip if NA)

26. Avoids unnecessary lengthy discussion

27. Informs about sources to take help from (skip if NA)

Rubric

1 = Poor

2 = Borderline poor

3 = Borderline satisfactory

4 = Satisfactory

5 = Good

6 = Excellent

7 = Outstanding

Assessment type and scoring

Formative assessment

Low stakes assessment

Coupled with feedback

Other than skip items, should meet at minimum the satisfactory for all of the items

Reliability Assurance

Items are clear

Items are not double barreled

Total number of items exceed 20

Several items check for key concepts/constructs

Training of the study team

Pilot testing the study team and tool

Multiple observations

Multiple raters

Reliability analysis

For internal consistency: ICC

Inter item correlation

Item to total correlation

Split half reliability (Cronbach alpha)

Test retest reliability

For inter rater reliability: Pearson Correlation

Validation methods

Face Validation: Seeking experts’ opinion Content validation:

1. Experts

2. Relevant literature

Construct validation:

1. Relevant literature

2. Experts

Consequent validation:

- Piloting, Repeated field tests

Minimizing Bias

Clear items

No double barreled items

Appropriate phrasing of items

Easy to follow

Not too lengthy

No or minimum recall items

Training the observers; pre testing the raters and tool at pilot

Ethical considerations

Informed consent for assessment from the assessed

Non sharing of the assessment with non concerned ones

Non disclosure of identity of the assessed

References

1. WHO / UNICEF: Alma Ata Declaration, 1978

2. UNICEF: Multiple Indicators Cluster Survey, 2008

3. UNICEF, WHO, UNESCO, UNFPA, UNDP & UNAIDS: Facts for Life, 3rd Edition, 2002

4. WHO: Information Series on School Health, Document No. 9 of 2001

Acknowledgment

All the course faculty for facilitation throughout

All the members of support staff for help, and

All the course mates for active contribution to my learning through IPs, at group work and off & on consultation