Evidence-based training of frontline health workers for door-to-door health promotion: a pilot randomized controlled cluster trial with Lady Health Workers in Sindh Province, Pakistan.
OBJECTIVE
Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers (LHWs) in Sindh, Pakistan.


METHODS
A baseline study on mothers and children provided local evidence for risk communication tools designed and tested by LHWs. The communities were randomized to intervention and control. LHWs visited women before and after childbirth to discuss safe practices in pregnancy, in the intervention group LHW using the new tools and in the control group using their standard procedures. A household survey and focus groups permitted assessment of the impact of the intervention.


RESULTS
Women in the intervention communities were more likely to attend prenatal checkups, to stop routine heavy work during pregnancy, to give colostrum to newborn babies, and to maintain exclusive breastfeeding for four months. Community focus groups confirmed a positive reaction to the tools.


CONCLUSIONS
Discussion by lay health workers of local evidence underlying safe motherhood messages improved uptake of protective health practices.


CONCLUSIONS
Door-to-door health promotion based on culturally appropriate interaction around relevant evidence can have a positive impact on health practices. Engaging health workers from the onset builds capacities, improves dialogue within the health system and performance of frontline health workers.
Omer
Khalid
K
CIET in Pakistan, Karachi, Pakistan. komer@ciet.org
Mhatre
Sharmila
S
Ansari
Noor
N
Laucirica
Jorge
J
Andersson
Neil
N
D001294:Attitude to Health; D002983:Clinical Competence; D016000:Cluster Analysis; D003142:Communication; D003150:Community Health Workers / Q000193:education* / Q000458:organization & administration / Q000523:psychology; D019317:Evidence-Based Medicine / Q000193:education* / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D010154:Pakistan; D010290:Parents / Q000193:education / Q000523:psychology; D036801:Parturition; D010353:Patient Education as Topic / Q000458:organization & administration; D010865:Pilot Projects; D011181:Postnatal Care; D011295:Prenatal Care; D011369:Professional-Patient Relations; D015397:Program Evaluation