Table 1 Comparison of uptake goals and implementation procedures for three categories of research on behaviour change interventions delivered by community health workers (CHWs)
Type of research | Validity and causal inferences1 | Level of control over experimental conditions1 | Goals for level of uptake2 | CHW to household ratio | System for CHW management and supervision |
|---|---|---|---|---|---|
Efficacy research | Focus on internal validity: can we draw causal inferences between interventions received and outcomes observed? | Highly controlled, farther from real-world conditions | Technology uptake: optimal Behavioural uptake: optimal | Less than 1/100, not a real-world ratio | Continuous oversight, typically 2–3 times per month. CHWs replaced within 1 month of attrition or critically low performance |
Effectiveness research | Focus on external validity: can the results be generalized to programmatic settings with near-real world conditions? | Less controlled, near real-world conditions | Technology uptake: near optimal Behavioural uptake: routine | Ratio based on national Ministry of Health (MOH) policy. Ongoing technical support from NGO staff3 | Periodic oversight, typical monthly or less. Facilitation of problem resolution by non-governmental organization (NGO) |
Implementation research | Focus on external validity: can the results be generalized to programmatic settings with real-world conditions? | Not controlled, real-world conditions | Technology uptake: routine Behavioural uptake: routine | Ratio based on national MOH policy. Limited technical support from NGO staff4 | Oversight depends on research question Limited external facilitation of problem resolution |