How We Train Community Health Workers Matters: A Cluster-Randomized Trial of an Innovative Approach to Boosting Maternal and Child Health Impact and Reduce Child Stunting in Peru
1
1 Academic Department of Public Health, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
2
2 Future Generations Global Network, Future Generations University, Franklin, United States
3
3 Nutrition Research Institute, Lima, Peru
4
4 Department of Population, Family and Reproductive Health, The Johns Hopkins University - Bloomberg School of Public Health, Baltimore, United States
Popul. Med. 2026;8(Supplement Supplement 1):A1041
ABSTRACT
INTRODUCTION:
A key to improving health globally is mothers’ adoption of healthy practices in the first 1000 days. This challenge is acute where access to health information is poor, educational levels are low, and traditional beliefs are strong. To support mothers’ adoption of healthy practices, we tested a new teaching/learning method called “Sharing Histories” to improve the behavior-change capacities of female community health workers (CHWs) by building on their autobiographical memories of childbearing and child care. Research from psychology, communications, and neuroscience helps to explain how this method works.
METHODS:
We conducted an embedded cluster-randomized controlled trial in 18 matched and randomized clusters with 82,000 inhabitants in rural Peru. Each cluster was a primary health care (PHC) facility jurisdiction. PHC staff trained female CHWs using Sharing Histories (experimental clusters) or standard training methods (control clusters) in modular training focused the first 1000 days: pregnancy, birth/postpartum, newborn, breastfeeding, feeding/growth, diarrhea, pneumonia. Training content and health system-strengthening interventions were held constant. CHWs in both study arms visited pregnant women and children 0-23 months monthly to teach, monitor, and refer. Primary outcome was stunting (low height-for-age) in children <24 months. Household surveys were conducted at baseline (N=606) and four-year follow-up (N=606).
RESULTS:
Maternal and child characteristics were similar in both study arms at baseline and follow-up. Analysis used difference-in-differences and multivariate generalized estimating equation (GEE). Among literate mothers, mean HAZ improved by 1.03 Z-scores in experimental versus control clusters from baseline to endline (p=.059). GEE models showed significant reduction of stunting in children of literate mothers visited by experimentally- versus standard-trained CHWs.
CONCLUSIONS:
Women with culturally-rooted beliefs have needs for special teaching/learning methods such as Sharing Histories to change MNCH practices. For PHC staff who are not educators, Sharing Histories is easy to learn and to incorporate into government CHW programs.1,2,3
A key to improving health globally is mothers’ adoption of healthy practices in the first 1000 days. This challenge is acute where access to health information is poor, educational levels are low, and traditional beliefs are strong. To support mothers’ adoption of healthy practices, we tested a new teaching/learning method called “Sharing Histories” to improve the behavior-change capacities of female community health workers (CHWs) by building on their autobiographical memories of childbearing and child care. Research from psychology, communications, and neuroscience helps to explain how this method works.
METHODS:
We conducted an embedded cluster-randomized controlled trial in 18 matched and randomized clusters with 82,000 inhabitants in rural Peru. Each cluster was a primary health care (PHC) facility jurisdiction. PHC staff trained female CHWs using Sharing Histories (experimental clusters) or standard training methods (control clusters) in modular training focused the first 1000 days: pregnancy, birth/postpartum, newborn, breastfeeding, feeding/growth, diarrhea, pneumonia. Training content and health system-strengthening interventions were held constant. CHWs in both study arms visited pregnant women and children 0-23 months monthly to teach, monitor, and refer. Primary outcome was stunting (low height-for-age) in children <24 months. Household surveys were conducted at baseline (N=606) and four-year follow-up (N=606).
RESULTS:
Maternal and child characteristics were similar in both study arms at baseline and follow-up. Analysis used difference-in-differences and multivariate generalized estimating equation (GEE). Among literate mothers, mean HAZ improved by 1.03 Z-scores in experimental versus control clusters from baseline to endline (p=.059). GEE models showed significant reduction of stunting in children of literate mothers visited by experimentally- versus standard-trained CHWs.
CONCLUSIONS:
Women with culturally-rooted beliefs have needs for special teaching/learning methods such as Sharing Histories to change MNCH practices. For PHC staff who are not educators, Sharing Histories is easy to learn and to incorporate into government CHW programs.1,2,3
| eISSN: | 2654-1459 |
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