Empowering Community Health Workers With Scripted Medicine: Design Science Research Study
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Notice bibliographique
Résumé
BACKGROUND: The World Health Organization anticipates a shortage of 14 million health workers by 2030, particularly affecting the Global South. Community health workers (CHWs) may mitigate the shortages of professional health care workers. Recent studies have explored the feasibility and effectiveness of shifting noncommunicable disease (NCD) services to CHWs. Challenges, such as high attrition rates and variable performance, persist due to inadequate organizational support and could hamper such efforts. Research on employee empowerment highlights how organizational structures affect employees' perception of empowerment and retention. OBJECTIVE: This study aims to develop Scripted Medicine to empower CHWs to accept broader responsibilities in NCD care. It aims to convey relevant medical and counseling knowledge through medical algorithms and ThinkLets (ie, social scripts). Collaboration engineering research offers insights that could help address the structural issues in community-based health care and facilitate task shifting. METHODS: This study followed a design science research approach to implement a mobile health-supported, community-based intervention in 2 districts of Lesotho. We first developed the medical algorithms and ThinkLets based on insights from collaboration engineering and algorithmic management literature. We then evaluated the designed approach in a field study in the ComBaCaL (Community Based Chronic Disease Care Lesotho) project. The field study included 10 newly recruited CHWs and spanned over 2 weeks of training and 12 weeks of field experience. Following an abductive approach, we analyzed surveys, interviews, and observations to study how Scripted Medicine empowers CHWs to accept broader responsibilities in NCD care. RESULTS: Scripted Medicine successfully conveyed the required medical and counseling knowledge through medical algorithms and ThinkLets. We found that medical algorithms predominantly influenced CHWs' perception of structural empowerment, while ThinkLets affected their psychological empowerment. The different perceptions between the groups of CHWs from the 2 districts highlighted the importance of considering the cultural and economic context. CONCLUSIONS: We propose Scripted Medicine as a novel approach to CHW empowerment inspired by collaboration engineering and algorithmic management. Scripted Medicine broadens the perspective on mobile health-supported, community-based health care. It emphasizes the need to script not only essential medical knowledge but also script counseling expertise. These scripts allow CHWs to embed medical knowledge into the social interactions in community-based health care. Scripted Medicine empowers CHW to accept broader responsibilities to address the imminent shortage of medical professionals in the Global South.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,006 | 0,002 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,006 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle