Enhancing the Knowledge and Behaviors of Fieldworkers to Promote Family Planning and Maternal, Newborn, and Child Health in Bangladesh Through a Digital Health Training Package: Results From a Pilot Study

Abstract

Community health workers, also known as fieldworkers (FWs), are frontline health-care providers in Bangladesh, where unmet need in family planning outcomes related to maternal and child health are high. A digital health intervention provided netbook computers to Bangladeshi FWs with eLearning courses and an eToolkit, which included material on family planning, maternal, newborn, and child health topics to enhance FWs’ knowledge and skills. To understand how the intervention affected FW’s knowledge and counseling behavior, this pre-poststudy measured FWs’ knowledge related to family planning, maternal, newborn, child health, and counseling on family topics before and after the pilot. Bivariate analyses were used to determine changes in FW knowledge, and multivariate analyses were conducted to determine changes in behavior, comparing knowledge and behaviors prepilot to postpilot. Comparing mean knowledge scores after and before the pilot, the difference in mean scores was significant ( p < .05) related to knowledge of benefits of birth spacing (1.26) and benefits of a small family (1.3) and related to maternal health, anemia prevention (0.95), and recommended number of antenatal care visits (0.13). Regarding newborn and child health, the difference in mean scores was significantly ( p < .05) related to knowledge of proper attachment for breastfeeding (3.56) and signs of adequate breast milk supply (1.08). Postintervention, FWs were significantly more likely to counsel couples on all available contraceptive options (adjusted odds ratio: 4.64; 95% CI [3.16, 6.83]) and birth spacing benefits (adjusted odds ratio: 4.54; 95% CI [3.17, 6.50]). Digital health training approaches can improve FWs’ knowledge and counseling skills within an international context, specifically in low-resource settings.