By: Simon Moore
Community health workers (CHWs) support millions of people living with, or at risk of, HIV in Southern Africa. They are often people’s first point of contact with the health system. However, to play an effective role, CHWs need access to up-to-date, clear, accurate, and user-friendly information on HIV and sexual health. There are currently few ways for CHWs to get this information, and many still rely on word of mouth for new information, with the biases and misinformation that can follow.
Studies have indicated that the majority of mobile health interventions focus on data collection and monitoring, or providing communication channels between CHWs and clinics. Interventions that are focused on training and education tend to be formal, providing CHWs with a set curriculum, or training around specific clinical guidelines. There are few resources that provide CHWs with a self-directed and exploratory way to get instant answers to questions that arise in their work.
This feature describes Boost, a new digital information and capacity-building resource for CHWs and CHW programs developed by Avert that wants to change that. Boost is designed for CHWs providing HIV and sexual health services in the Southern Africa region, or CHWs in other areas who need quick access to information about HIV and sexual health. Currently in beta version, Boost is being piloted in 2020 and is fully functioning and open to organizations wishing to use and test it.
Purpose and objectives
The project set out to explore the information gaps on HIV and sexual health for CHWs in Southern Africa and develop content and a delivery mechanism to fill those gaps. Avert worked with groups of CHWs across the region to ensure both the content and mode of delivery were relevant and appropriate. The result is a new progressive web app called Boost – data light and downloadable for offline use.
Boost aims to improve CHW1 effectiveness and ability to support individuals in their communities to make informed decisions on HIV and sexual health and to stay healthy. It hosts a range of targeted materials aimed at individual CHWs, the clients of CHWs (individuals seeking or in need of support from CHWs), and organisations that train, develop and support CHWs.
Launched in January 2020, Boost provides clear, up-to-date, visual, and interactive materials on HIV and sexual health.
Scoping work on Boost started in February 2019. The process included in-country focus group discussions with over 100 CHWs in Malawi, Zambia, and Zimbabwe – from peer educators to formal government cadres. Through meetings with organisations working with CHWs in these countries, the project team sought to better understand how Boost might support and complement the work that they do with CHWs. Desk research also examined the community health landscape in Southern Africa, the training CHWs receive, and how previous interventions have supplied CHWs with ongoing learning opportunities.
A number of scoping findings guided the development of Boost:
- Ongoing training is seen to be one of the most neglected areas in community health, with some projects failing to provide CHWs any ongoing support.
- The majority of m-health interventions have focused on data collection and monitoring or providing communication channels between CHWs and clinics. Those that are focused on training and education tend to be more formal, providing CHWs with a set curriculum, or training around specific clinical guidelines. There are few resources that aim to provide a way for CHWs to get answers to questions that arise in their work in a more self-directed and exploratory way.
- Mobile data is often expensive. Previous m-health interventions have failed to understand the costs that will be incurred by the health workers using mobile technologies.
- Training alone is not able to fully equip CHWs with the broad knowledge they need to answer the full range of challenges and questions they meet in their work.
- Existing processes to support the ongoing learning of CHWs can be unreliable, depending on the projects and health facilities they work with.
- Finding information is currently a slow, time-consuming process for CHWs.
- CHWs lack engaging materials to use with members of their communities.
- To ensure the usability of any new intervention and the relevance of the materials developed, CHWs must be central to the design and content development.
- Many organisations are creating their own materials to support the cadres of CHWs that they work with. They acknowledge that this is a time-consuming, expensive process, which doesn’t necessarily match the skills or the core aims of their organisation, and which they would be glad not to need to do.
- CHWs say that having resources designed specifically for them, answering the common questions they face, would be timesaving and helpful. It would help them increase the support that they are able to offer their communities, meaning that they are able to answer more questions, on a wider range of topics, in a more efficient and accurate way.
The scoping findings contributed to Boost’s design. Following the scoping work, a series of user panels of CHWs from Zimbabwe, Zambia and Malawi were set up using Whatsapp groups. These user panels were involved throughout Boost’s development and kept CHWs central to content creation, design and functionality. Two organisational case study partners in Zimbabwe, working nationally with CHWs, also contributed to defining content and user testing of the app. They also carried out a survey on mobile phone ownership and use with nearly 400 CHWs.
These case study partners in Zimbabwe are now rolling out the app, running familiarisation sessions with their CHWs. This will not only ensure there is a fully skilled cohort of test users, but will provide immediate feedback on any problems people have using the app, which can be fed through into iterative improvements.
Other organisations and individuals can now freely access and download Boost. It will be promoted across the Southern African region, and there will be a new Facebook group set up to provide some community support for those engaging with the app.
Boost is designed with three groups in mind: first and foremost are CHWs themselves. Boost fills the information gaps they have identified in their day-to-day work – giving simple, engaging information that makes their roles easier. Second, Boost is a tool for organisations that are working with CHWs, providing an easy, free means to support the ongoing updating of their CHWs’ knowledge, and to link in with their organisation’s wider support structures. For example, one of our pilot partners in Zimbabwe, OPHID, is planning to use Boost to supplement physical meetings between CHWs and their mentors.
Third, Boost has an indirect audience of beneficiaries within CHW-supported communities. Built into Boost is a ‘presentation mode’ that enables CHWs to use Boost content to explain things directly to clients during meetings. The CHW can also share visual ‘slides’ from the app with clients or other CHWs via Whatsapp. This share function enables CHWs to provide clients with key take-aways from their meeting.
The look, feel and functionality of Boost have all been led by participants in the Whatsapp user groups. Consulted at each step of the way, these panels have emphasised the importance of the app being simple, easy to use and image-led. The groups have tested and fed back on the user interface to make sure it is user-friendly – with app use kept consistent across all its parts, so it’s quick to pick up. There are built-in help screens to get people started, and it uses gestures and icons familiar to u
sers from other common apps and websites. The aim has been for individuals to be comfortable using Boost without any need for formal training.
During the pilot phase Boost content is only available in English, but overall the app is text-light and image-led, making the content widely accessible. Based on feedback, and securing additional funding, the hope is to explore other language versions in a second phase of the project.
Some of the other features of Boost include:
- Search across all content easily
- Quizzes and myth busting to make learning interactive
- Presentation mode for use with clients
- Create an account to track your progress and store preferences
- Badges and awards to incentivise learning
- Share content from Boost via Whatsapp to others
- Mark and store your favourites
- Glossary with simple explanations of key terms
- New content notifications
Monitoring, evaluating and learning from the pilot
Boost is a free resource and we are keen that as many individuals and organisations as possible use it and provide feedback on their experience. The monitoring, evaluation and learning framework has been designed to allow wide participation and easy data gathering.
Some of the areas we hope to learn about from the pilot include: How do CHWs interact with digital information? What information content do they access? Does it improve their knowledge and confidence? How do they use the content to support individuals in their communities? And do those individuals feel benefits as a result? Does Boost provide value to organisations in the ongoing development of CHWs? And to what extent does a downloadable progressive web app expand access to digital information for those with limited connectivity?
Boost will provide automated analytics data through the app itself, including the frequency of use and type of content viewed. It will be possible to segment this data by organisational affiliation, enabling us to provide information about usage for organisations who use the app.
Our user panels, involved throughout the co-creation stage, will also provide qualitative information about how they use Boost after launch. User panel members will participate in guided discussions via a Whatsapp group, online surveys and in-person interviews about their experience of using the app.
Our two case study partners in Zimbabwe will also roll Boost out to a cohort of around 200 of their CHWs. They will support the facilitation of interviews and focus group discussions with CHWs and beneficiaries to capture qualitative data at the start, middle and end of the six-month pilot phase.
In September 2020 we will be publishing an evaluation of the pilot phase of the project to report on progress and findings.
Interested in using Boost? Individual community health workers can go to https://boost.avert.org to get started.
If you are an organisation in Southern Africa and would like to use Boost as an organisational tool for your community health workers then get in touch and register with Avert. Registering will enable us to include your organisation in the app’s drop-down organisational menu so we can segment the data that is automatically collected by the app. We can then provide your organisation with anonymised insights on how often Boost is being used, by how many of your community health workers, and what content they find most helpful.
1. For the project, ‘community health worker’ is understood as an umbrella term covering individuals in different roles including peer educators, behaviour change facilitators, community mobilisers, home-based care givers and many more.
Simon Moore is Director of Communications and Digital Health Strategy at AVERT