This work is part of a larger study in Zambia known as Better Health Outcomes through Mentoring and Assessment (BHOMA), which is a stepped wedge community randomised controlled trial that aims to strengthen the health system in three rural districts of Zambia. The BHOMA intervention is being implemented in Chongwe, Luangwa and Kafue Districts, all in Lusaka Province, Zambia. The combined population for the 3 districts is 306,000, with a total of 48 health facilities and 4 general hospitals. Two separate but complementary packages are being applied in the BHOMA intervention: the health facility package (which targets the health workers and their support staff through training, mentoring and support) and the community-based package (which works within the community to improve access to health services and improve data and referral systems).
The BHOMA intervention is complex and labor intensive, and is therefore being rolled out gradually from one health facility to the next over a period of 3 years using a stepped wedged design
[23 (link),24 ]. The full intervention and the evaluation design are described elsewhere (Mutale et al., unpublished
[19 ]. A baseline health facility survey was conducted in 42 out 48 health facilities found in the 3 BHOMA districts between January and April 2011. This constituted 96% of the total health facilities, with the rest being used as pilot sites for the BHOMA intervention.
In this study, we interviewed 1 to 3 health workers at each of the 42 health facilities who were present at the time of baseline data collection, depending on the available staff. Most health facilities had just one eligible health worker. Where there were more than three, up to three health workers were randomly selected to take part in the study. They were eligible if they had been working in the facility for at least 1 month and were attending to patients. All participants were given instructions about the tool, which was self-administered though the respondents were free to clarify questions that they did not understand. Before being used in the Zambian setting, the tool was pretested and questions were adapted to suit the lower level health facilities but the content remained essentially the same as described by Mbindyo et al.
[22 (link)].
The data collection tool was selected as it was easy to use and there is no available tool that has been used in Zambia previously. It is hoped that the assessment will be repeated after 12 months in the same health facilities to determine any changes. The tool had 23 items, with answers given on a scale of 1 to 5 (strongly agree to strongly disagree) (Table
1 ). The items with negative statements were reverse coded when calculating scores.
Data was entered into a Microsoft access database (Microsoft, Redmond, WA, USA) and exported to SPSS version 19 (SPSS, Chicago, IL, USA) for analysis. Factor analysis was used to confirm latent factors described by Mbindyo et al.
[22 (link)]. The scores were standardized to 100 in order to allow for comparison between subscores. The overall scores were calculated by the sum of all subscores of the latent factors described. Linear regression was used to identify determinants of motivation.
The BHOMA intervention is complex and labor intensive, and is therefore being rolled out gradually from one health facility to the next over a period of 3 years using a stepped wedged design
[23 (link),24 ]. The full intervention and the evaluation design are described elsewhere (Mutale et al., unpublished
[19 ]. A baseline health facility survey was conducted in 42 out 48 health facilities found in the 3 BHOMA districts between January and April 2011. This constituted 96% of the total health facilities, with the rest being used as pilot sites for the BHOMA intervention.
In this study, we interviewed 1 to 3 health workers at each of the 42 health facilities who were present at the time of baseline data collection, depending on the available staff. Most health facilities had just one eligible health worker. Where there were more than three, up to three health workers were randomly selected to take part in the study. They were eligible if they had been working in the facility for at least 1 month and were attending to patients. All participants were given instructions about the tool, which was self-administered though the respondents were free to clarify questions that they did not understand. Before being used in the Zambian setting, the tool was pretested and questions were adapted to suit the lower level health facilities but the content remained essentially the same as described by Mbindyo et al.
[22 (link)].
The data collection tool was selected as it was easy to use and there is no available tool that has been used in Zambia previously. It is hoped that the assessment will be repeated after 12 months in the same health facilities to determine any changes. The tool had 23 items, with answers given on a scale of 1 to 5 (strongly agree to strongly disagree) (Table
Data was entered into a Microsoft access database (Microsoft, Redmond, WA, USA) and exported to SPSS version 19 (SPSS, Chicago, IL, USA) for analysis. Factor analysis was used to confirm latent factors described by Mbindyo et al.
[22 (link)]. The scores were standardized to 100 in order to allow for comparison between subscores. The overall scores were calculated by the sum of all subscores of the latent factors described. Linear regression was used to identify determinants of motivation.
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