title: 5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting.
abstract: BACKGROUND
  Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs.
  
  
  OBJECTIVE
  To apply an original, non-linear framework and case study method, 5-SPICE, to multiple sister projects of a large, international non-governmental organization (NGO), and other CHW projects.
  
  
  METHODS
  Engaging a large group of implementers, researchers and the best available literature, the 5-SPICE framework was refined and then applied to a selection of CHW programs. Insights gleaned from the case study method were summarized in a tabular format named the '5×5-SPICE charts'. This format graphically lists the ways in which essential CHW program elements interact, both positively and negatively, in the implementation field.
  
  
  RESULTS
  The 5×5-SPICE charts reveal a variety of insights that come from a more complex understanding of how essential CHW projects interact and influence each other in their unique context. Some have been well described in the literature previously, while others are exclusive to this article. An analysis of how best to compensate CHWs is also offered as an example of the type of insights that this method may yield.
  
  
  CONCLUSIONS
  The 5-SPICE framework is a novel instrument that can be used to guide discussions about CHW projects. Insights from this process can help guide quality improvement efforts, or be used as hypothesis that will form the basis of a program's research agenda. Recent experience with research protocols embedded into successfully implemented projects demonstrates how such hypothesis can be rigorously tested.
authors.affiliation: Partners In Health, Boston, MA, USA. dpalazuelos@pih.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Palazuelos
authors.forename: Kyla
authors.initials: K
authors.lastname: Ellis
authors.forename: Dana DaEun
authors.initials: DD
authors.lastname: Im
authors.forename: Matthew
authors.initials: M
authors.lastname: Peckarsky
authors.forename: Dan
authors.initials: D
authors.lastname: Schwarz
authors.forename: Didi Bertrand
authors.initials: DB
authors.lastname: Farmer
authors.forename: Ranu
authors.initials: R
authors.lastname: Dhillon
authors.forename: Ari
authors.initials: A
authors.lastname: Johnson
authors.forename: Claudia
authors.initials: C
authors.lastname: Orihuela
authors.forename: Jill
authors.initials: J
authors.lastname: Hackett
authors.forename: Junior
authors.initials: J
authors.lastname: Bazile
authors.forename: Leslie
authors.initials: L
authors.lastname: Berman
authors.forename: Madeleine
authors.initials: M
authors.lastname: Ballard
authors.forename: Raj
authors.initials: R
authors.lastname: Panjabi
authors.forename: Ralph
authors.initials: R
authors.lastname: Ternier
authors.forename: Sam
authors.initials: S
authors.lastname: Slavin
authors.forename: Scott
authors.initials: S
authors.lastname: Lee
authors.forename: Steve
authors.initials: S
authors.lastname: Selinsky
authors.forename: Carole Diane
authors.initials: CD
authors.lastname: Mitnick
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education* / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007391:International Cooperation; D009042:Motivation; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D012944:Social Support
keywords: case study; community health workers; conceptual framework; quality improvement; research
references.citation: Soc Sci Med. 2010 Oct;71(8):1375-8; discussion 1379-80
references.pmid: 20667639
references.citation: Contemp Clin Trials. 2007 Feb;28(2):182-91
references.pmid: 16829207
references.citation: Lancet. 2008 Jun 7;371(9628):1936-44
references.pmid: 18539225
references.citation: J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):e35-42
references.pmid: 22156912
references.citation: Health Care Superv. 1998 Sep;17(1):37-47
references.pmid: 10182173
references.citation: Ethn Dis. 2010 Spring;20(2):189-94
references.pmid: 20503902
references.citation: N Engl J Med. 2008 Aug 7;359(6):563-74
references.pmid: 18687637
references.citation: Harv Bus Rev. 2008 Jul-Aug;86(7-8):78-84, 160
references.pmid: 18681299
references.citation: Clin Infect Dis. 2013 May;56(9):1319-26
references.pmid: 23249611
references.citation: Soc Sci Med. 2010 Jun;70(12):1920-1927
references.pmid: 20382464
references.citation: BMJ. 2012 Mar 21;344:e1634
references.pmid: 22438367