Thursday, April 28, 2005

Evaluation of Job Aids for Laboratory Confirmation in Tanzania

Kathleen F. Cavallaro, Vincent Y. Mgaya, Ahmed Seha, Mohamed Amri, Thomas Aisu, Jeannette St. Pierre, Kirk P. Winger, and Peter Mmbuji.

Tanzania adopted an integrated disease surveillance and response (IDSR) strategy for priority diseases, but health workers lack protocols for planning and performing tasks required for laboratory confirmation of surveillance data. To support integration, partners developed “job-aids”—condensed, user-friendly references showing when and how to perform tasks.

Prior to implementation, partners evaluated draft job-aids to determine whether health workers found them useful, understandable, easy to follow, and feasible.

At district and regional primary care centers, participants reviewed job-aids and performed tasks referencing a job-aid and using provided materials. Participants included district or regional health workers responsible for patient care, laboratory, surveillance, prevention, control, or program management. Data were collected using standardized questionnaires, interviews, and observation checklists. Main outcome measures were assessments of the usefulness, understandability, ease of following and feasibility of using job-aids as measured on scale of 1-5, with 5 as highest rating level.

Twenty participants (4 districts) completed the evaluation in November 2003. Median self-reported ability to read English was 3.5 (range 2-5). Twenty (100%) stated they would use job-aids if available. Twenty (100%) participants found “Background”, “Documentation”, “Collection and Handling”, and “Using Transport Medium” sections easy to follow, while only 16 (84%) found “Transportation” easy to follow. Median ratings for usefulness and understandability of all sections were 4 out of 5 (range 1-5). Four (21%) found some graphics confusing. When asked about barriers to task performance, 11 (55%) identified staff, 15 (79%) transportation, 17 (85%) supplies, 12 (60%) communications, and 15 (75%) equipment.

Tanzanian health workers expressed a high level of satisfaction with job-aids for laboratory confirmation, but identified urgent needs for adequate supplies, equipment, staff, and training. Job-aids should be translated into local languages and improved based on feedback from the user. Districts should use job-aids to assess supply, staff and service needs.

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