A Cluster-Randomized Trial to Test Sharing Histories as a Training Method for Community Health Workers in Peru.

Area of Science:

• Global Health
• Maternal and Child Health
• Community Health Interventions

Background:

• Community health workers (CHWs) are vital for promoting healthy home practices in low- and middle-income countries.
• Effective training methods for CHWs in maternal health behavior change are not well understood.
• The Sharing Histories (SH) training method utilizes CHWs' personal experiences to enhance learning.

Purpose of the Study:

• To test the efficacy of the Sharing Histories (SH) training method for community health workers (CHWs).
• To evaluate the impact of SH training on reducing child stunting in rural Peru.
• To compare the effectiveness of SH training against standard CHW training methods.

Main Methods:

• An embedded cluster-randomized trial was conducted in rural Peru involving 18 matched clusters.
• Female CHWs received either SH training (experimental) or standard training (control).
• The primary outcome was the prevalence of stunting (height-for-age Z-scores <-2) in children aged 0-23 months, assessed via household surveys at baseline and 4-year follow-up.

Main Results:

• No significant difference in mean height-for-age Z-scores was observed between experimental and control clusters overall.
• A significant improvement in mean height-for-age Z-scores was noted in the subgroup of literate mothers in the experimental group (P=.059).
• Stunting was significantly reduced among children of literate mothers in the SH training group (Beta=0.77, P<.01).

Conclusions:

• The Sharing Histories (SH) training method shows potential for enhancing CHW effectiveness in reducing child stunting among literate mothers.
• Unaddressed determinants of stunting in children of illiterate mothers require further investigation.
• Tailored training approaches may be necessary to address diverse maternal and child health challenges.