Community health worker knowledge, attitudes and practices towards COVID-19: Learnings from an online cross-sectional survey using a digital health platform, UpSCALE, in Mozambique

  1. Mitra Feldman
  2. Vera Lacey Krylova
  3. Poppy Farrow
  4. Laura Donovan
  5. Edson Zandamela
  6. Joaquim Rebelo
  7. Maria Rodrigues
  8. Antonio Bulo
  9. Carlos Ferraz
  10. Humberto Rodrigues
  11. Arantxa Roca-Feltrer
  12. Kevin Baker

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Abstract

Healthcare workers (HCWs) are at the frontline of the Coronavirus Disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as agentes polivalentes elementares (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n = (25%), n = (16%) and n = (39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020. Adapting the existing upSCALE platform enabled a better understanding, in real time, of the KAP of APEs around COVID-19 management. Subsequently, supporting delivery of tailored messages and education, vital for ensuring a successful COVID-19 response.

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  1. Version published to 10.1371/journal.pone.0244924
  2. ScreenIT

    SciScore for 10.1101/2020.11.05.20216606: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableTo support the COVID-19 response in Mozambique, Malaria Consortium, in partnership with Ministry of Health and Dimagi, rapidly expanded the upSCALE platform and the use of telemedicine - through the use of short message service (SMS), training modules, monitoring of key indicators on routine services for women and children, stock control and disease surveillance.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of this KAP survey required the respondents to respond via the UpSCALE application on their functioning mobile. This limited the sample size and response rate to the survey. This could also have led to a certain level of respondent bias, as typically approximately 20% of users have non- functioning phones and limited internet access, further biasing responses towards less remote areas. We have planned to also issue a shorted KAP survey using standard SMS messaging for the second round of the KAP survey planned for November 2020, to allow more users to respond.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.05.20216606v1 on medRxiv