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Table 1 Evaluation framework

From: An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol

Aim Outcome/RE-AIM element Indicator Definition
Effectiveness Primary outcome 1: institutional birth Institutional birth rate % women delivering at a facility with a skilled birth attendant
Secondary outcome 1: child mortality Under-2 mortality rate # child deaths before age 2 per 1000 live births
Secondary outcome 2: post-partum contraception Post-partum contraceptive prevalence rate % post-partum women using a modern form of contraception
Implementation Reach Home visit coverage -% children under age 2 years receiving a CHW home visit, measured monthly
-% pregnant women receiving a home visit by a CHW, measured monthly
-% reproductive aged women receiving a pregnancy surveillance home visit, measured quarterly
-% postpartum women receiving 1+ balanced counseling session, measured biannually
Group participation % scheduled participants completing group sessions, measured monthly
Session completion % scheduled group sessions completed, measured monthly
Demographic, geographic barriers and facilitators Mapping households, describing barriers/facilitators to individuals’ access, and identifying contributors to variation/inequities
Efficacy Pregnancy identification % all pregnancies identified in first 12 weeks
ANC completion -% women at 9+ months gestation completing 4+ ANC visits at a health care facility and eligible for government financial incentive out of total # of women delivered, measured monthly
-% pregnant women who receive an obstetric ultrasound by their due date, measured monthly
-% pregnant women with prenatal labs completed by 6 months gestation, measured monthly
Exclusive breastfeeding prevalence % infants age 0–5 months who are exclusively breastfed, measured monthly
Pediatric pneumonia incidence # new cases of pneumonia in children under age 2 years, measured monthly
Pediatric stunting prevalence # children under age 2 years whose length-for-height/height-for-age is < 2 SDs WHO child growth standards median, measured monthly
Unmet contraceptive need % eligible reproductive-age women within 12 months postpartum who desire to either stop or postpone childbearing for the next 2 years who are not currently using a modern contraceptive method or have a repeat unintended pregnancy while not using modern contraception, measured monthly
Contraception method mix % women within 12 months postpartum using each method of modern contraception, measured quarterly
Contraception initiation and continuation Contraceptive initiation and continuation probabilities at 3, 6, 12, and 24 months after method initiation, measured quarterly
Adoption Village cluster adoption % intended village clusters receiving intervention
Timely adoption % intended village clusters rolling-out intervention within 3 months of schedule
CHW adoption -# CHWs hired/trained in intervention implementation
-# CHWs who resign
Government adoption -% group care sessions co-facilitated by a government health worker
-# collaborative care meetings with government partners during implementation
Implementation Supervision model -% scheduled supervision field visits completed, stratified by CHN and district
-# data review meetings held with CHWs and CHNs, measured quarterly
Group care content fidelity % planned topics covered at each session, measured monthly
Home visit fidelity -% women with “adequate” number of home visits received
-% appropriate ANC topics covered during each pregnancy care home visit
-% child health topics covered during each under 2 home visit
-% balanced counseling points covered at each postpartum contraception counseling session, measured biannually
Referral completeness % referrals completed as prescribed by the clinical algorithm
Implementation challenges Exploratory and hypothesis-generating as revealed through FGDs and KIIs
Maintenance Total intervention cost Cost of each intervention component and total costs using the Time Defined Activity Based Costing (TDABC) method
Cost per unit -Intervention cost per 1000 people
-Projected cost to scale intervention nationally
Maintenance cost % breakdown of maintenance costs (personnel, materials, and other)
Facility vs. community costs % of costs of health care divided between facility level and community level
Geographic cost variation Variation of costs between village clusters and districts
Out-of-pocket patient costs % costs of health care divided between facility level and community level
Integrated intervention cost-effectiveness Pre/post intervention marginal effectiveness for primary outcomes, not account for secondary effects (e.g., increasing the costs of care through increased cesarean sections)