A Quasi-Experimental Study to Assess the Effectiveness of a Structured Training Program on Newborn Care Based on ASHA Module 7 - "Skills That Saves Lives" in Terms of Reported Practice among ASHA Workers in a Selected Community of Delhi.

BACKGROUND: Newborn health and survival depend on the care given to the newborn, although newborn care is a very essential element in reducing child mortality, it often receives less than optimum attention.
OBJECTIVES: The objective of this study was (1) to develop a structured training program for ASHA workers on newborn care based on ASHA module 7 "Skills that saves lives." (2) To compare the reported practices of ASHA workers with regard to newborn care before and after the administration of structured training program. (3) To determine the association between the practice scores and the selected demographic data, i.e., age, years of experience, and education. (4) To assess the acceptability of ASHA workers about training programs regarding newborn care.
MATERIALS AND METHODS: Quantitative research approach was selected with one group pre- and posttest design. A random sampling technique was used for the selection of ASHA workers. A structured practice questionnaire on newborn care was prepared to assess the practices of ASHA workers and a structured opinionnaire to assess the acceptability of the training program. RESULT: The findings revealed that the mean of posttest scores (25.6) was higher than the mean of pretest scores (14.5) with a mean difference of 11.1. There was no association between practice scores and selected demographic variables, i.e., age, years of experience, and educational status of ASHA workers.
CONCLUSION: The structured training program on newborn care was effective in improving the practices of ASHA workers. Copyright:

INTRODUCTION

Newborns are considered to be tiny and powerless, completely dependent on others for life. Neonates are “at risk” for various health problems, even though they are born with average birth weights. The morbidity and mortality rates in newborn infants are high. They need optimal care for improved survival. There are many factors responsible for newborn deaths that comprise of-preterm (this means a baby born before date), infections to mother, death at the time of delivery, and throughout postnatal period. This is the most critical time when mother and child require expertise care. Numerous reasoning can be correlated to why the newborn health has been ignored, even though there is a hike in the mortality rates and why most neonatal deaths are undocumented and unseen. The child survival programs have helped to lowering the number of death rates among children under-5 years over the past 25 years, the biggest impact has been on reducing mortality from diseases that influence infants and children over 1-month-old.[1]

In India, between 2008 and 2016, the death rate for children under the age of 5 declined by about 43%, from 69 to 39 per 1000 live births. Yet, this success was not reflected in the death rate for newborns; the death rate for newborns, in the 1st month of life, was reduced by only 31%, from 35 to 24 per 1000 live births over the same period.[2] The primary health center provides routine and emergency care of sick children including IMNCI strategy and inpatient care. From here, babies are shifted to the new age centers and care is provided by the health team to preserve the neonate. This is also called as first referral units. If the newborn required specially designed care, then team representatives refer the baby to the extraordinary care units which are situated at territory hospitals. They provide ventilators and care after surgery or any operative procedures. This is the second phase. Special baby units were set up in a public hospital in one of the undeveloped localities in the state of West Bengal. These were managed by a nonprofit organization, but the documentation of usefulness and efficiency of newborn care was not maintained properly by them. It was observed that when we will increase the newborn services that results in the reduction of death's in the hospital area and then further leads to decline in neonatal mortality of the entire district.[3]

MATERIALS AND METHODS

The study was conducted in Government Dispensary, Mangolpuri, New Delhi. In the present study, a quasi-experimental pre- and posttest randomized one group design is adopted in order to achieve the objectives. The sample comprised 60 ASHA workers of the selected community of Delhi. The structured practice questionnaire on newborn care (Tool-I) was used as a tool which consists of II parts.

Part I includes the demographic profile of ASHA workers which contained 5 items

Part II includes a checklist to assess the reported practices of ASHA workers on newborn care which contained 30 items. As shown in Table 1.

Table 1

Major Domains

Domains	Number of items	Item related to
First domain	12	High-risk assessment
Second domain	9	Breastfeeding
Third domain	5	Sepsis management
Fourth domain	4	When to refer the baby

There are a total of 30 items in the tool. Score of “one” is given for yes and “zero” for no. The maximum score is 30 and minimum score is 0.

Tool 2 was a structured opinionnaire which was developed to determine the opinion of ASHA workers regarding the acceptability and utility of the training program in relation to the adequacy of the content, clarity of language, interest building factors, usefulness, and demonstration. The opinionnaire comprised of 10 items, each with three alternative responses as to a great extent, some extent, and not at all.

The reliability of the structured opinionnaire was established by Cronbach's alpha method. The reliability coefficient of the structured opinionnaire was found to be 0.91. The structured opinionnaire was found to be reliable. The reliability of SPQN was assessed using Cronbach's alpha method and reliability coefficient was found to be 0.82. The purpose of the investigation was explained to the group and confidentiality of their responses was assured. The pretest was administered to ASHA workers on Day 1. On Day 2, Day 3, and Day 4, topics of the newborn were taught to them that is introduction to low birth weight baby, assessment and management of low birth weight baby, breastfeeding for babies with low birth weight, management of sepsis, and when to refer the baby. The training was followed by demonstrations that is monitoring of body temperature by using a digital thermometer, measuring of weight by using spring balance and the techniques of breast feeding. Posttest was conducted on Day 10. A structured opinionnaire was administered to evaluate the utility and acceptability of the training program on the 10th day.

RESULTS

Demographic characteristics of the ASHA workers

Demographic characteristics include age, education, years of experience, marital status, and in-service education attended of ASHA workers. Majority of ASHA workers (65%) belonged to the age group of 31–40 years, 26.7% belonged to the age group of 41–50 years, and 8.3% belonged to the age group of 21–30 years. With regard to years of experience, 76.7% of ASHA workers were having 3–4 years of experience and 23.3% were having 5–6 years of experience. With regard to the educational status of the ASHA workers, 30% were educated up to the middle level and 70% were educated up to the higher secondary level. Regarding marital status, 100% of ASHA workers were married. Data related to in-service education attended 100% of ASHA workers have attended in-service education.

Comparison of pre- and posttest practice scores of ASHA workers

From the data presented in Table 2, it is seen that the average score before training was 14.5 and after training, it was 25.6 which is showing a very good improvement of 11.1 units and is statistically significant at P < 0.05.

Table 2

Mean, standard deviation, and ‘t’ value of pre-posttest practice scores of accredited social health activist workers

Training program	Mean scores	SD	t	P
Pre	14.5	2.7	26.9	<0.05
Post	25.6	1.5

SD: Standard deviation

Comparison of pre- and postintervention scores domain wise/category wise

Data in Figure 1 show that the mean in high-risk assessment was 7.1 and standard 4 before training, whereas after teaching, the mean was found to be 10.3 and the standard deviation was 1.2. In the breastfeeding section, the mean was 3.3 and the standard deviation was 2.5, but after the intervention, the mean was 7.8 and standard deviation was 1.0. In the third domain that is sepsis management, the mean was 1.9 and standard deviation was 1.8 before education and after the intervention, the mean was found to be 4.3 and standard deviation 0.7. In the fourth domain that is when to refer the baby, the mean was found to be 2.1 and standard deviation was 1.5 before the intervention, whereas after the intervention, the mean was calculated to be 2.1 and standard deviation was 1.5, but after the intervention, the mean was 3.3 and standard deviation was 0.7. Postintervention is showing a good improvement in practice score in all areas.

Figure 1

Multiple bar diagram showing pre- and postintervention mean category/domain wise that is high-risk assessment, breastfeeding, sepsis management, and when to refer the child

Association of practice scores of ASHA workers with selected variables, i.e., age, years of experience, and education

Fisher exact test was used to determine the association between the score levels and selected demographic variables. This shows that there is no significant association between the level of scores and demographic variables. The Fisher exact test value was less than the table value at the 0.05 level of significance.

Acceptability of training program on newborn care among ASHA workers

Data presented in Table 3 reveal that 80% of ASHA workers found that the training program was effective, whereas 20% found that the training program was effective to some extent. About 80% found the training program impressive, whereas 20% found the training program impressive to some extent. 100% of ASHA workers found the training program relevant to a great extent. 86% of ASHA workers found the training program was easy to understand. 100% of ASHA workers found that the training program was simple to follow to a great extent. 87% found that the training program is logical, whereas 13% found the training program logical to some extent. 80% of ASHA workers found that training program helped them to retain the content, whereas 20% found that training programs helped them to retain the content to some extent. Majority (88%) of ASHA found that demonstration was helpful in understanding the content to a great extent, whereas 12% found that demonstration was helpful to understand the content to some extent. 74% of ASHA workers found that the duration of the training program was sufficient to a great extent, whereas 26% found that the duration of the training program was sufficient to some extent.

Table 3

Frequency and percentage distribution of the opinion of accredited social health activist workers regarding the acceptability of the training program on newborn care

Statements	Frequency (%)
	Great extent	Some extent
Training program was effective	12 (80)	3 (20)
Training program is impressive	12 (80)	3 (20)
Training program is relevant	15 (100)	0 (0)
Training program is interesting	13 (86)	2 (14)
Training program is easy to understand	13 (86)	2 (14)
Language used was simple to follow	15 (100)	0 (0)
Training program is logical	13 (87)	2 (13)
Training program helped me to retain content	12 (80)	3 (20)
Demonstration was helpful in understanding the content	13 (88)	2 (12)
Duration of the program was sufficient	11 (74)	3 (26)
Overall percentage	86.10	13.90

DISCUSSION

The present study confirmed the effectiveness of a structured training program on the practices of ASHA workers. This finding is in accordance with the study conducted by Stalin in Faridabad, which revealed that there was an improvement in the practices of ASHA workers after giving 1-day training program.[4] A similar study was conducted by Chandra, this study acknowledges that the practices related to newborn care services provided by the trained traditional birth attendants were poor. In this research, posttest was given to the experimental group which shows that there was a progressive improvement in the newborn care. The present study found no association between the practice scores with selected demographic variables, that is, age, years of experience, and educational status.[5] Likewise, Susham assessed the effectiveness of the training course of ASHA on infant feeding practices and concluded that the training program is very effective in improving the ASHA worker practices.[6] Darshan conducted a study on ASHA workers which shows that there was no association found between the knowledge, practice, and attitude with education and total duration of services.[7]

Another study conducted by Vinod which concluded that there is a significant association between knowledge on newborn care and selected demographic variables such as education, but there is no significant association between other variables such as age, area of residence, employment status, economic status, religion, and status of the family.[8] Thus, the present study findings conclude that the training program on newborn care is very effective in improving the practices of ASHA workers. However, multiple assessments and trainings will be an additional help for achieving goals of home-based newborn care in the future.

CONCLUSION

The study concludes that the structured training program on newborn care was adequate, useful, potent, and impressive and it helps in improving the practices of ASHA workers. This also shows that there was an actual difference between the mean of pre- and posttest practice scores of ASHA workers. There was no significant association between the practice scores and selected demographic variables, i.e., age, years of experience, and educational status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.