IncentivesNCT05176106
Advancing the Health of Rural Communities in Uganda Through Strong Community Health Programs
A study testing CHW Incentives Intervention in people with Incentives and Health Behavior, run by Johns Hopkins Bloomberg School of Public Health at 1 site in Uganda.
Trial summary
The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Incentives, Health Behavior, Health Care Utilization
- What is being tested?
- CHW Incentives Intervention
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 769 participants
- Where
- 1 siteUganda
- Study dates
- 23 Aug 2021to 15 Mar 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Must be an active VHT in Uganda's Masindi district.
Who cannot join
- Anyone who fails to meet the inclusion criteria specified above will be excluded.
Trial locations and contacts
1 site in 1 country.
About this study
The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor.
Read the detailed description
Uganda, like several countries in Sub-Saharan Africa, faces a shortage of skilled healthcare workers, and a disproportionate concentration of workers in urban areas. This disparity has dire consequences for rural populations, who have higher fertility rates, lower utilization of maternal and child health services, lower levels of access to safe drinking water and sanitation services, and poorer vaccination coverage. Women and children in rural and remote communities bear the disproportionate brunt of poor access to and poor quality of health care. Village Health Teams (VHTs), Uganda's community health workers (CHW), were introduced to address some of these inequities by providing basic health services to the rural poor. However, like many CHW programs globally, the VHT program has high levels of attrition, owing to inadequate systems and financial support.
The objectives of this study are to understand:
- What structure and group of incentives is best suited to motivate VHTs, improve their performance in the delivery of services, and increase their retention in the health workforce?
- What is the behavioral mechanisms through which new incentives may work or fail to work?
- How do the changes in the national VHT program impact utilization of maternal and child health services, sanitary practices, and perception of quality of health services at the community-level? What is the impact of COVID-19 on VHT practices on community health?
This study will evaluate a 1-year incentives intervention provided to VHTs in Uganda's Masindi District. It is a two-armed clinical trial, where parishes will be randomized to the incentives intervention (i.e., an incentives package will be provided to VHTs practicing in the intervention parishes; control parishes VHTs will not receive an incentives package). The primary outcomes include assessing VHT performance, VHT motivation, VHT retention, trends in utilization of maternal and child health services, and trends in the adoption of sanitary practices. Outcomes for VHT performance, VHT retention, trends in utilization of maternal and child health services, and trends in adoption of sanitary practices will be measured monthly. Outcomes for VHT motivation will be measured twice, at baseline (Month 1) and endline (Month 12).
- Conditions
- Incentives, Health Behavior, Health Care Utilization
- Being tested
- CHW Incentives Intervention
- Keywords
- Community Health Workers, Incentives, Uganda, Motivation, Retention, Performance
- Medical subject headings
- Health Behavior, Patient Acceptance of Health Care
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CHW Incentives InterventionBehavioural
The intervention comprises of an incentives package provided to VHTs who are active in the intervention-randomized parishes. It will comprise of items that will motivate them and support their work as VHTs in the community.
| Study group | Role | What they receive |
|---|---|---|
| Intervention-Randomized Parishes | Experimental | Parishes will be randomized in Masindi District to receive the intervention (i.e., an incentives package). VHTs who are active in that parish will thereby receive the incentives intervention. Receives: Behavioral: CHW Incentives Intervention |
| Control-Randomized Parishes | No intervention | Non-intervention randomized parishes will be the control parishes. Active VHTs in the control parishes will not receive the incentives intervention. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in VHT Performance
Measure change in average number of VHT visits made over the course of the 1-year intervention. Types of VHT visits include: average number of home visits, antenatal care visits, postnatal care visits, visits to support immunization of children, visits to talk about safe drinking water, visits to examine latrines and observe handwashing, and number of referrals made to the health facility over the last month.
Measured: Measured monthly for 12 months
Change in VHT Motivation
Measure the percentage of VHTs who have improved motivation during the course of the 1-year intervention through use of the Close-To-Community (CTC) Provider Motivational Indicator Scale, which measures satisfaction, organizational commitment, community commitment, and work conscientiousness.
Measured: Baseline (Month 1) and Endline (Month 12)
Change in VHT Retention
Measure the percentage of VHTs who report to the health facility over the course of the 1-year intervention.
Measured: Measured monthly for 12 months
Change in Maternal and Child Health Services Utilization
Measure change in maternal and child health services utilization, which includes proportion of antenatal care coverage, proportion of immunization coverage, and proportion of children under 5 who have been visited by a VHT, over the course of the 1-year intervention.
Measured: Measured monthly for 12 months
Change in Adoption of Sanitary Practices
Measure changes in the adoption of sanitary practices, which includes assessing the average number of households with latrines, improved latrines, handwashing facilities, safe drinking water, and are open defecation free over the course of the 1-year intervention.
Measured: Measured monthly for 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Jan 2022
- Study start23 Aug 2021
- Primary completion15 Mar 2023
- Study completion15 Mar 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for IncentivesStudies of the same condition, open and under way.
- More trials run by Johns Hopkins Bloomberg School of Public HealthThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Parishes will be randomized to intervention or control. VHTs in the intervention parishes will receive the incentives package as part of the intervention.
- Masking
- None (open label)
- Enrolment
- 769 participants (actual)
Sponsor and investigators
- Lead sponsor
- Johns Hopkins Bloomberg School of Public Health
- Sponsor type
- University, hospital or other
- Collaborators
- Makerere University
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05176106
- Sponsor's protocol ID
- IRB00015042
- Status last verified
- Jul 2023
- First submitted
- 1 Nov 2021
- Last updated
- 25 Jul 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: We will not be sharing individual participant data. All data that will be shared will be at the aggregate-level so that any identifying information is not identifiable and does not place the participant at additional risk.
Publications
Agarwal S, Tweheyo R, Pandya S, Obuya E, Kiyomoto A, Mitra P, Schleiff M, Nagpal T, Macis M, Rutebemberwa E. Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: a study protocol for a cluster randomized controlled trial. Trials. 2023 Jun 23;24(1):428. doi: 10.1186/s13063-023-07426-6.
PubMed 37353798
Study at a glance
From the registry record, last updated by the sponsor on 25 Jul 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Advancing the Health of Rural Communities in Uganda Through Strong Community Health Programs
- ClinicalTrials.gov ID
- NCT05176106
- Acronym / sponsor ID
- IRB00015042
- Conditions
- Incentives, Health Behavior, Health Care Utilization
- Keywords
- Community Health Workers, Incentives, Uganda, Motivation, Retention, Performance
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 769 participants (actual)
- Lead sponsor
- Johns Hopkins Bloomberg School of Public HealthUniversity, hospital or other
- Collaborators
- Makerere University
- Study start
- 23 Aug 2021 (actual)
- Primary completion
- 15 Mar 2023 (actual)
- Study completion
- 15 Mar 2023 (actual)
- First posted
- 4 Jan 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor.
Detailed description
Uganda, like several countries in Sub-Saharan Africa, faces a shortage of skilled healthcare workers, and a disproportionate concentration of workers in urban areas. This disparity has dire consequences for rural populations, who have higher fertility rates, lower utilization of maternal and child health services, lower levels of access to safe drinking water and sanitation services, and poorer vaccination coverage. Women and children in rural and remote communities bear the disproportionate brunt of poor access to and poor quality of health care. Village Health Teams (VHTs), Uganda's community health workers (CHW), were introduced to address some of these inequities by providing basic health services to the rural poor. However, like many CHW programs globally, the VHT program has high levels of attrition, owing to inadequate systems and financial support.
The objectives of this study are to understand:
- What structure and group of incentives is best suited to motivate VHTs, improve their performance in the delivery of services, and increase their retention in the health workforce?
- What is the behavioral mechanisms through which new incentives may work or fail to work?
- How do the changes in the national VHT program impact utilization of maternal and child health services, sanitary practices, and perception of quality of health services at the community-level? What is the impact of COVID-19 on VHT practices on community health?
This study will evaluate a 1-year incentives intervention provided to VHTs in Uganda's Masindi District. It is a two-armed clinical trial, where parishes will be randomized to the incentives intervention (i.e., an incentives package will be provided to VHTs practicing in the intervention parishes; control parishes VHTs will not receive an incentives package). The primary outcomes include assessing VHT performance, VHT motivation, VHT retention, trends in utilization of maternal and child health services, and trends in the adoption of sanitary practices. Outcomes for VHT performance, VHT retention, trends in utilization of maternal and child health services, and trends in adoption of sanitary practices will be measured monthly. Outcomes for VHT motivation will be measured twice, at baseline (Month 1) and endline (Month 12).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Parishes will be randomized to intervention or control. VHTs in the intervention parishes will receive the incentives package as part of the intervention.
| Arm | Type | Receives |
|---|---|---|
| Intervention-Randomized Parishes | Experimental | Behavioral: CHW Incentives InterventionParishes will be randomized in Masindi District to receive the intervention (i.e., an incentives package). VHTs who are active in that parish will thereby receive the incentives intervention. |
| Control-Randomized Parishes | No intervention | –Non-intervention randomized parishes will be the control parishes. Active VHTs in the control parishes will not receive the incentives intervention. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Must be an active VHT in Uganda's Masindi district.
Key exclusion criteria (1 listed)
- Anyone who fails to meet the inclusion criteria specified above will be excluded.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CHW Incentives InterventionThe intervention comprises of an incentives package provided to VHTs who are active in the intervention-randomized parishes. It will comprise of items that will motivate them and support their work as VHTs in the community. | Behavioural | Intervention-Randomized Parishes |
Primary outcome
Change in VHT Performance
Time frame: Measured monthly for 12 months
Measure change in average number of VHT visits made over the course of the 1-year intervention. Types of VHT visits include: average number of home visits, antenatal care visits, postnatal care visits, visits to support immunization of children, visits to talk about safe drinking water, visits to examine latrines and observe handwashing, and number of referrals made to the health facility over the last month.
Change in VHT Motivation
Time frame: Baseline (Month 1) and Endline (Month 12)
Measure the percentage of VHTs who have improved motivation during the course of the 1-year intervention through use of the Close-To-Community (CTC) Provider Motivational Indicator Scale, which measures satisfaction, organizational commitment, community commitment, and work conscientiousness.
Change in VHT Retention
Time frame: Measured monthly for 12 months
Measure the percentage of VHTs who report to the health facility over the course of the 1-year intervention.
Change in Maternal and Child Health Services Utilization
Time frame: Measured monthly for 12 months
Measure change in maternal and child health services utilization, which includes proportion of antenatal care coverage, proportion of immunization coverage, and proportion of children under 5 who have been visited by a VHT, over the course of the 1-year intervention.
Change in Adoption of Sanitary Practices
Time frame: Measured monthly for 12 months
Measure changes in the adoption of sanitary practices, which includes assessing the average number of households with latrines, improved latrines, handwashing facilities, safe drinking water, and are open defecation free over the course of the 1-year intervention.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Jul 2023.
- Derived from this study: PubMed 37353798Agarwal S, Tweheyo R, Pandya S, Obuya E, Kiyomoto A, Mitra P, Schleiff M, Nagpal T, Macis M, Rutebemberwa E. Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: a study protocol for a cluster randomized controlled trial. Trials. 2023 Jun 23;24(1):428. doi: 10.1186/s13063-023-07426-6.
- Individual participant dataSharing planned: No. We will not be sharing individual participant data. All data that will be shared will be at the aggregate-level so that any identifying information is not identifiable and does not place the participant at additional risk.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing CHW Incentives Intervention in people with Incentives and Health Behavior, run by Johns Hopkins Bloomberg School of Public Health at 1 site in Uganda.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 25 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Uganda. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in VHT Performance (time frame: Measured monthly for 12 months). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05176106, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jul 2023.