Study Protocol for a Randomized Health and Social Literacy Intervention to Improve Maternal Health in Pakistan

Authors

  • Sara Rizvi Jafree (PhD) Department of Sociology, Forman Christian College University, Lahore – Pakistan https://orcid.org/0000-0001-5141-1107
  • Humna Ahsan (PhD) Department of Economics, Forman Christian College University, Lahore – Pakistan https://orcid.org/0000-0003-0067-995X
  • Rubeena Zakar (PhD) Department of Public Health, University of the Punjab, Lahore – Pakistan https://orcid.org/0000-0001-9546-3742
  • Anam Muzamill (PhD) Department of Mass Communication, Forman Christian College University, Lahore – Pakistan https://orcid.org/0000-0002-0191-9970
  • Syeda Khadija Burhan Department of Education, Forman Christian College University, Lahore – Pakistan https://orcid.org/0000-0003-1202-8900
  • Ambreen Javed (PhD) Department of English, Forman Christian College University, Lahore – Pakistan
  • Rana Rubab Durrani Center for Language Development, Forman Christian College University, Lahore – Pakistan https://orcid.org/0009-0001-0991-0807
  • Florian Fischer (PhD) Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin – Germany https://orcid.org/0000-0002-4388-1245

DOI:

https://doi.org/10.48112/aessr.v4i4.905

Abstract

Abstract Views: 758

Many poor and illiterate women in reproductive years in Pakistan live in underdeveloped areas and are solely dependent on free primary health services provided by the state through the Lady Health Worker (LHW) Programme. These women need higher health and social literacy to make informed health decisions and receive inferior services from overburdened LHWs. This project aims to deliver a health and social literacy intervention by integrating Community Social Workers (CSWs) at the primary level to promote maternal health in the country. A 24-month intervention with six health and social literacy modules will be delivered by trained CSWs. Multistage randomized sampling will be used to sample 6 BHUs across six cities from six districts of Punjab, Pakistan. A total of 360 women will be sampled and assigned randomly to the experiment and control groups. Pakistan needs to catch up on its sustainable development goals for maternal health, not just due to the limitations of the existing services, but also due to the low health and social literacy of women, which prevents effective uptake. Each LHW is expected to have an estimated 1,500 women clients for multiple services, which makes support for women’s literacy and awareness difficult. Integrating a partner workforce or CSWs to support disadvantaged women for improved maternal health outcomes is critically needed. The results of this intervention will advise policymakers and stakeholders about long-term plans for literacy support of women and the integration of CSWs in the primary healthcare setup.

Keywords:

Community social workers, Health literacy, Lady health worker, Maternal health, Primary healthcare, Social literacy

Author Biographies

Sara Rizvi Jafree (PhD),

She is an Associate Professor at the Department of Sociology, Forman Christian College University in Lahore – Pakistan.  She obtained her Post-Doc Degree in Social Policy from the University of Oxford in Oxford – United Kingdom.

Humna Ahsan (PhD),

She is an Assistant Professor at the Department of Economics, Forman Christian College University in Lahore – Pakistan.  She obtained her Doctorate Degree in Economics from the University of Manchester in Manchester – England.

Rubeena Zakar (PhD),

She is a professor at the Department of Public Health and Director of the Institute of Social and Cultural Studies, University of the Punjab in Lahore – Pakistan. She obtained her Doctorate in Public Health from Bielefeld University in Bielefeld – Germany.

Anam Muzamill (PhD),

She is an Assistant Professor at the Department of Mass Communication, Forman Christian College University in Lahore – Pakistan.  She obtained her Doctorate Degree in Communication Studies from University of the Punjab in Lahore – Pakistan.

Syeda Khadija Burhan,

She is an Assistant Professor at the Department of Education, Forman Christian College University in Lahore – Pakistan.  She obtained her M.Phil.  Degree in Education from the University of Education in Lahore – Pakistan.

Ambreen Javed (PhD),

She is an Assistant Professor at the Department of English, Forman Christian College University in Lahore – Pakistan.  She obtained her Doctorate Degree in Linguistics from Fatima Jinnah Women University in Rawalpindi – Pakistan.  

Rana Rubab Durrani,

She is a Lecturer at the Center for Language Development, Forman Christian College University in Lahore – Pakistan. She obtained her Master’s Degree in TESOL from Beaconhouse National University in Lahore – Pakistan.  

Florian Fischer (PhD),

She is a Lecturer at the Institute of Public Health, Charité - Universitätsmedizin Berlin in Berlin – Germany. She obtained her Post-Doc Degree in Public Health from Bielefeld University in Bielefeld – Germany.

References

Abdullah, M., & Zakar, P. D. R. (2020). Health literacy in South Asia: Clarifying the connections between health literacy and wellbeing in Pakistan. South Asian Studies, 34(2).

Afsar, H. A., & Younus, M. (2005). Recommendations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the health workers perspective. Journal of Ayub Medical College, 17(1), 48. https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/559

Ahmed, J., & Shaikh, B. T. (2011). The state of affairs at primary health care facilities in Pakistan: where is the state's stewardship?. Eastern Mediterranean Health Journal, 17(7).

Ariff, S., Soofi, S. B., Sadiq, K., Feroze, A. B., Khan, S., Jafarey, S. N., ... & Bhutta, Z. A. (2010). Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an assessment of their training needs. BMC Health Services research, 10, 1-9. https://doi.org/10.1186/1472-6963-10-319

Arthur, J., & Davison, J. (2000). Social literacy and citizenship education in the school curriculum. The Curriculum Journal, 11(1), 9-23. https://doi.org/10.1080/095851700361366

Arthur, J., Davison, J., & Stow, W. (2014). Social literacy, citizenship education and the national curriculum. Routledge.

Ashcroft, R., McMillan, C., Ambrose-Miller, W., McKee, R., & Brown, J. B. (2018). The emerging role of social work in primary health care: a survey of social workers in Ontario family health teams. Health & Social Work, 43(2), 109-117. https://doi.org/10.1093/hsw/hly003

Az-Zahra, H. R., Sarkadi, S., & Bachtiar, I. G. (2018). Students’ Social Literacy in their Daily Journal. Mimbar Sekolah Dasar, 5(3), 162-173. https://doi.org/10.53400/mimbar-sd.v5i3.12094

Banks, S. (2020). Ethics and values in social work. Bloomsbury Publishing.

Baum, F., Sanderson, C., & Jolley, G. (1997). Community participation in action: an analysis of the South Australian Health and Social Welfare Councils. Health Promotion International, 12(2), 125-134. https://doi.org/10.1093/heapro/12.2.125

Buchmann, N., Field, E., Glennerster, R., Nazneen, S., Pimkina, S., & Sen, I. (2018). Power vs money: Alternative approaches to reducing child marriage in Bangladesh, a randomized control trial. Abdul Latif Jameel Poverty Action Lab (J-PAL) working paper.

Budosan, B. (2011). Mental health training of primary health care workers: case reports from Sri Lanka, Pakistan and Jordan. Intervention, 9(2), 125-136.

Chan, A. W., Tetzlaff, J. M., Altman, D. G., Laupacis, A., Gøtzsche, P. C., Krleža-Jerić, K., ... & Moher, D. (2017). SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Japanese Pharmacology and Therapeutics, 45(12), 1895-1904.

Dhavaleshwar, C. U. (2016). The role of social worker in community development. International Research Journal of Social Sciences, 5(10), 61-63.

Dussault, G., Kawar, R., Castro Lopes, S., & Campbell, J. (2018). Building the primary health care workforce of the 21st century-Background paper to the Global Conference on Primary Health Care: From Alma-Ata Towards Universal Health Coverage and the Sustainable Development Goals. Geneva: World Health Organization.

Facione, P. A. (2011). Critical thinking: What it is and why it counts. Insight Assessment, 1(1), 1-23.

Glennerster, R., Walsh, C., & Diaz-Martin, L. (2018). A practical guide to measuring women’s and girls’ empowerment in impact evaluations. Gender Sector, Abdul Latif Jameel Poverty Action Lab.

Goujon, A., Wazir, A., & Gailey, N. (2020). Pakistan: A population giant falling behind in its demographic transition. Population Societies, 576(4), 1-4.

Gross, A. M., Gross, J., & Eisenstein-Naveh, A. R. (1983). Defining the role of the social worker in primary health care. Health & Social Work, 8(3), 174-181. https://doi.org/10.1093/hsw/8.3.174

Habib, S. S., Jamal, W. Z., Zaidi, S. M. A., Siddiqui, J. U. R., Khan, H. M., Creswell, J., ... & Versfeld, A. (2021). Barriers to access of healthcare services for rural women—applying gender lens on TB in a rural district of Sindh, Pakistan. International Journal of Environmental Research and Public Health, 18(19), 10102. https://doi.org/10.3390/ijerph181910102

Hafeez, A., Mohamud, B. K., Shiekh, M. R., Shah, S. A. I., & Jooma, R. (2011). Lady health workers programme in Pakistan: challenges, achievements and the way forward. JPMA. The Journal of the Pakistan Medical Association, 61(3), 210. https://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurg/248

Hesselink, A. E., Verhoeff, A. P., & Stronks, K. (2009). Ethnic health care advisors: a good strategy to improve the access to health care and social welfare services for ethnic minorities?. Journal of Community Health, 34, 419-429. https://doi.org/10.1007/s10900-009-9171-7

Hickey, K. T., Creber, R. M. M., Reading, M., Sciacca, R. R., Riga, T. C., Frulla, A. P., & Casida, J. M. (2018). Low health literacy: Implications for managing cardiac patients in practice. The Nurse Practitioner, 43(8), 49-55. https://doi.org/10.1097/01.NPR.0000541468.54290.49

Hutchison, B., Levesque, J. F., Strumpf, E., & Coyle, N. (2011). Primary health care in Canada: systems in motion. The Milbank Quarterly, 89(2), 256-288. https://doi.org/10.1111/j.1468-0009.2011.00628.x

Jafree, S. R., Khawar, A., Ul Momina, A., & Mahmood, Q. K. (2022). Infection preparedness of community health workers: implications for maternal and neonatal health services in Pakistan. Primary Health Care Research & Development, 23, e27. https://doi.org/10.1017/S1463423622000081

Jafree, S. R., Zakar, R., & Anwar, S. (2020). Women’s role in decision-making for health care in South Asia. The Sociology of South Asian Women’s Health, 55-78. https://doi.org/10.1007/978-3-030-50204-1_4

Jefferys, M. (1965). The Organisation of Community Health and Welfare Services. Social Work (1939-1970), 22(2/3), 19-28. https://www.jstor.org/stable/43760862

Jordan, B. (2000). Social Work and the Third Way: Tough love as social policy. Sage.

Kanu, J. S., Tang, Y., & Liu, Y. (2014). Assessment on the knowledge and reported practices of women on maternal and child health in rural Sierra Leone: a cross-sectional survey. PloS one, 9(8), e105936. https://doi.org/10.1371/journal.pone.0105936

Lady Health Workers’ Strategic Plan (2022). Primary Health Care for Universal Health Coverage, Government of Pakistan Report. Retrieved: https://lmis.gov.pk/docs/uhc/2022%20LHWs%20Strategic%20Plan_V11.pdf

Lakhani, A., Jan, R., Mubeen, K., Karimi, S., Shahid, S., Sewani, R., ... & Adnan, F. (2016). Strengthening the knowledge and skills of community midwives in Pakistan through clinical practice internships. Journal of Asian Midwives (JAM), 3(2), p. 26-38. http://ecommons.aku.edu/jam/vol3/iss2/4

Larsen, A. T., Klausen, M. B., & Højgaard, B. (2020). Primary Health Care in the Nordic Countries: Comparative Analysis and Identification of Challenges. Copenhagen, DK: VIVE–The Danish Center for Social Science Research.

Lassi, Z., Kahn, Z., & Zulliger, R. (2020). Pakistan’s lady health worker program. Health for the People: National Community Health Worker Programs from Afghanistan to Zimbabwe, 315-327.

Lee, M., Kang, B. A., & You, M. (2021). Knowledge, attitudes, and practices (KAP) toward COVID-19: a cross-sectional study in South Korea. BMC Public Health, 21, 1-10. https://doi.org/10.1186/s12889-021-10285-y

Malik, M. A., Gul, W., & Abrejo, F. (2015). Cost of primary health care in Pakistan. Journal of Ayub Medical College, Abbottabad, 27(1), 88. https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/164

Malik, M. A., Nahyoun, A. S., Rizvi, A., Bhatti, Z. A., & Bhutta, Z. A. (2017). Expenditure tracking and review of reproductive maternal, newborn and child health policy in Pakistan. Health Policy and Planning, 32(6), 781-790. https://doi.org/10.1093/heapol/czx021

Marnı, S., Alıman, M., & Harsıatı, T. (2020). Students’ critical thinking skills based on gender and knowledge group. Journal of Turkish Science Education, 17(4), 544-560.

Mitchell, S. M., & Shortell, S. M. (2000). The governance and management of effective community health partnerships: a typology for research, policy, and practice. The Milbank Quarterly, 78(2), 241-289. https://doi.org/10.1111/1468-0009.00170

Nyqvist, M. B., & Jayachandran, S. (2017). Mothers care more, but fathers decide: Educating parents about child health in Uganda. American Economic Review, 107(5), 496-500. https://doi.org/10.1257/aer.p20171103

Olsen, L., Saunders, R. S., & Yong, P. L. (Eds.). (2011). The healthcare imperative: lowering costs and improving outcomes: workshop series summary. National Academies Press.

Panezai, S., Ahmad, M. M., & Saqib, S. E. (2017). Factors affecting access to primary health care services in Pakistan: a gender-based analysis. Development in Practice, 27(6), 813-827. https://doi.org/10.1080/09614524.2017.1344188

Pawar, M. (2019). Social work and social policy practice: Imperatives for political engagement. The International Journal of Community and Social Development, 1(1), 15-27. https://doi.org/10.1177/2516602619833219

Phommachanh, S., Essink, D. R., Wright, P. E., Broerse, J. E., & Mayxay, M. (2021). Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos. Plos one, 16(3), e0244181. https://doi.org/10.1371/journal.pone.0244181

Pivoriene, J., & Bardauskiene, R. (2016). Social work with families at social risk promoting gender equality. In SHS Web of Conferences (Vol. 30, p. 00024). EDP Sciences. https://doi.org/10.1051/shsconf/20163000024

Riaz, S. (2018). Social Case Work Practice in Pakistan: A Situational Analysis of Social Welfare Officers Working in Public Hospitals. Journal of Research in Social Sciences, 6(1), 259-276.

Rohde, J., Cousens, S., Chopra, M., Tangcharoensathien, V., Black, R., Bhutta, Z. A., & Lawn, J. E. (2008). 30 years after Alma-Ata: has primary health care worked in countries?. The Lancet, 372(9642), 950-961. https://doi.org/10.1016/S0140-6736(08)61405-1

Saxe Zerden, L. D., Lombardi, B. M., & Jones, A. (2019). Social workers in integrated health care: Improving care throughout the life course. Social Work in Health Care, 58(1), 142-149. https://doi.org/10.1080/00981389.2019.1553934

Shaikh, S., Baig, L. A., Hashmi, I., Khan, M., Jamali, S., Khan, M. N., ... & Zaib, S. (2020). The magnitude and determinants of violence against healthcare workers in Pakistan. BMJ Global Health, 5(4), e002112. https://doi.org/10.1136/bmjgh-2019-002112

Ssewanyana, D., Van Baar, A., Newton, C. R., & Abubakar, A. (2018). A contextually relevant approach to assessing health risk behavior in a rural sub-Saharan Africa setting: the Kilifi health risk behavior questionnaire. BMC Public Health, 18, 1-12. https://doi.org/10.1186/s12889-018-5710-4

Svanemyr, J., Baig, Q., & Chandra-Mouli, V. (2015). Scaling up of life skills based education in Pakistan: A case study. Sex Education, 15(3), 249-262. https://doi.org/10.1080/14681811.2014.1000454

Szwajcer, E., Hiddink, G. J., Maas, L., Koelen, M., & Van Woerkum, C. (2012). Nutrition awareness before and throughout different trimesters in pregnancy: a quantitative study among Dutch women. Family Practice, 29(suppl_1), i82-i88. https://doi.org/10.1093/fampra/cmr107

Tadic, V., Ashcroft, R., Brown, J. B., & Dahrouge, S. (2020). The role of social workers in interprofessional primary healthcare teams. Healthcare Policy, 16(1), 27. https://doi.org/10.12927/hcpol.2020.26292

Tariq, I., Aslam, T., & Khan, M. A. (2021). Impact of selected social welfare programs on poverty alleviation and health outcomes in Pakistan. Journal of Humanities, Social and Management Sciences (JHSMS), 2(1), 214-232.

Tunio, M. N., Chaudhry, I. S., Shaikh, S., Jariko, M. A., & Brahmi, M. (2021). Determinants of the sustainable entrepreneurial engagement of youth in developing country—An empirical evidence from Pakistan. Sustainability, 13(14), 7764. https://doi.org/10.3390/su13147764

Wadsworth, Y. (1982). The politics of social research: a social research strategy for the community health, education and welfare movement. Australian Journal of Social Issues, 17(3), 232-246. https://doi.org/10.1002/j.1839-4655.1982.tb00738.x

Walt, G., Ross, D., Gilson, L., Owuor-Omondi, L., & Knudsen, T. (1989). Community health workers in national programmes: the case of the family welfare educators of Botswana. Transactions of the Royal Society of Tropical Medicine and Hygiene, 83(1), 49-55. https://doi.org/10.1016/0035-9203(89)90703-7

Wasi, N. (2022). The Place and Role of Pakistan in United Nations Organizations. Global Pakistan: Pakistan‟ s Role in the International System, 125.

Wazir, M. S., Shaikh, B. T., & Ahmed, A. (2013). National program for family planning and primary health care Pakistan: a SWOT analysis. Reproductive Health, 10, 1-7. https://doi.org/10.1186/1742-4755-10-60

Weiss-Gal, I., & Gal, J. (2014). Social workers as policy actors. Journal of Social Policy, 43(1), 19-36. https://doi.org/10.1017/S0047279413000603

Weiss-Gal, I., & Gal, J. (2020). Explaining the policy practice of community social workers. Journal of Social Work, 20(2), 216-233. https://doi.org/10.1177/1468017318814996

World Bank. (2011). Social Protection in Health: What Are the Options for Pakistan?. World Bank.

World Health Organization. (2017). Primary health care systems (PRIMASYS): comprehensive case study from Pakistan (No. WHO/HIS/HSR/17.37). World Health Organization.

Yaqoob, T., Mir, F., Abbas, H., Shahid, W. B., Shafqat, N., & Amjad, M. F. (2017, October). Feasibility analysis for deploying national healthcare information system (NHIS) for Pakistan. In 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom) (pp. 1-6). IEEE. https://doi.org/10.1109/HealthCom.2017.8210836

Zain, S., Jameel, B., Zahid, M., Munir, M., Kandasamy, S., & Majid, U. (2021). The design and delivery of maternal health interventions in Pakistan: a scoping review. Health Care for Women International, 42(4-6), 518-546. https://doi.org/10.1080/07399332.2019.1707833

Zakar, R., Zakar, M. Z., Aqil, N., Chaudhry, A., & Nasrullah, M. (2017). Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012–13. Journal of Obstetrics and Gynaecology, 37(3), 330-337. https://doi.org/10.1080/01443615.2016.1250728

Published

2024-11-30

How to Cite

Jafree, S. R., Ahsan, H., Zakar, R., Muzamill, A., Burhan, S. K., Javed, A., … Fischer, F. (2024). Study Protocol for a Randomized Health and Social Literacy Intervention to Improve Maternal Health in Pakistan. Academy of Education and Social Sciences Review, 4(4), 643–655. https://doi.org/10.48112/aessr.v4i4.905

Issue

Section

Study Protocols

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.