Table 3 Examples of studies of water, sanitation and hygiene interventions conducted in Bangladesh corresponding to the three categories of research on behaviour-change interventions delivered by community health workers (CHWs)
Type of research | Example of this type of research | Scale, setting and duration of study | CHW to household ratio | System for CHW oversight, training and intervention dissemination |
|---|---|---|---|---|
Efficacy research | WASH Benefits Bangladesh study1 | Population; ~ 4169 intervention households; Location: 4 rural sub-districts Duration; 2012–2015 (2-year intervention exposure) | 1:8 CHWs; N = 540 | CHW oversight; Coordinated by study team (Fig. 3) Transparent and rigorous recruitment criteria and methods Identified as employee to maintain morale and prestige in the community Delivery skills formally assessed Accessible supervision, ~ 12 CHWs/supervisor CHWs received study technologies to encourage CHW and recipient self-efficacy Stipend paid using mobile phone network Training: Provided by project staff Refreshers: scheduled and triggered by fidelity measures Included messages on study staff withdrawal and intervention sustainability Dissemination; Based on communication plan and IBM-WASH theoretical model2 Evaluated messages were understood by recipients Community meetings during roll out for acceptability, expectation management, conflict reduction Sequenced technology and BCC component delivery for combined interventions |
Effectiveness research | Introduction of cholera vaccine in Bangladesh3 | Population; 240,000 Location: urban slums, Dhaka Duration: 2011–2013 (2-year intervention exposure) | 1:290 CHWs; N = 55 | CHW oversight Single NGO with close project staff involvement, ~ 16 CHWs/supervisor Training Delivered by NGO, developed by project staff Dissemination: NGO-hired CHWs from the local community-delivered interpersonal communications. NGO-delivered hardware |
Implementation research | Sanitation, hygiene Education and water supply in Bangladesh Health Impact Study4 | Population 20 million Location: 58 rural sub-districts Duration: 2007–2012 (4–5-year intervention exposure) | Up to 1:550 CHWs; N = 10,0005 | CHW oversight; multiple NGOs; individual NGOs responsible for hiring and supervision Training: multiple NGOs Dissemination: multiple NGO-hired CHWs from the local community, delivered interpersonal communications |