Health Promoters' Competence Assessment Tool (HCAT)

1. COMPETENCE ASSESSMENT TOOL
(CAT) FOR HEALTH EDUCATORS
Saeed Anwar

2. Problem Statement
 Health education - central to preventive and
promotive health services in primary care
 Health education is globally a component of
Primary Healthcare 1
 When talking of health educators, HE is their
exclusive job role
 HE sessions in our setting are as a rule going un -
assessed and un – monitored or in a poorly
monitored form

3. Magnitude of the problem
 Recent statistics on a few relevant health indicators are
cited below:
1. Under five mortality: 100/1000 live births
2. IMR: 76/1000 live births
3. Child immunization: 70%
4. Exclusive breastfeeding: 45%
5. MMR: 320/100 000 live births
6. CPR: 38%
7. Skilled birth attendance: 42%
8. Antenatal care: 47% 2

4.  HFs and schools are the usual community based
venues of HE
 HE mostly happens as a group activity
 Target audiences are often poor, rural people
mostly illiterate or with low literacy level

5. Priority themes/subthemes of HE
1. Birth spacing
2. Regular antenatal check up and skilled birth
attendance
3. Danger signs of pregnancy
4. Diet during pregnancy and lactation
5. Breastfeeding and weaning
6. Immunization
7. Growth Monitoring up to first 3 years of life
8. ORS use during diarrhea 3
*UNICEF’s Facts for Life will be used as reference for Issue Specific Key
Messages

6. Context
 Workplace based assessment of HE sessions with
the help of this assessment tool
 Public & private sector static community clinics in
flood affected districts (Charsadda and Nowshera)
 Plus point is that CHS itself got four static clinics in
flood affected districts including these districts (they
may serve as control)

7. Uses
 Workplace based assessment of various cadre
community educators, including lady health workers
 Formative and summative assessment of medical
students:
1. As workplace based assessment in community
2. On practical stations, and
3. Mini CEX

8. Questions in the mind?
 What are the priority competencies for a health
educator?
 Is there any pre - existing tool to measure those?
 If not, what about developing an indigenous one?
And
 Pilot test it for reliability assessment and validation

9. Literature Search
 Search done for HE skills, competencies and assessment
formats
 List of skills returned on search included:
1. Cultural competency skills
2. Communication and interpersonal skills
3. Negotiation/Refusal skills
4. Cooperation and teamwork skills
5. Advocacy skills
6. Critical thinking skills
7. Decision making skills
8. Problem solving skills, and
9. Coping and self management skills 4

10. Search ---
 Assessment format was found on communication for
training
 No format was found for the target HE skills
 However there were:
1. Guidelines to assess cultural competence of
organizations
2. Standards to evaluate organizational competence
for health promotion
3. Standard formats of IEC material, and
4. Check lists for patient education in clinical setting

11. Scope of the tool
 Its doesn’t claim comprehensive assessment of all the
HE competencies/skills at all
 Its focus is on assessing HE skills necessary for
effective conduction of community based HE sessions
 These include:
1. Time management skills
2. Organizational skills
3. Cultural skills, and
4. Communication skills to effectively get across the
issue specific key messages to community groups

12. Type of scale
 7 Items adjectival rating scale

13. Rating scale
SKILL ITEMS
Cultural skills 1. Session takes care of socio - cultural norms
2. People are greeted in culturally appropriate way
3. Session breaks for prayer well in time (skip if NA)
Time management skills 4. Session duration is shared at start
5. Session closes on time
Organizational skills 6. Overall organization for the session is appropriate
7. Support material is at hand
8. Support material is pre deployed at right place(s)
Communication skills 9. Introduces self appropriately
10. Shares purpose of the session
11. Maintains eye contact with the group
12. Non verbal cues match the verbal communication
13. Explains technical term(s) in easy language (skip if NA)

14. Scale ---
SKILL Item
Communication skills 14. Communicates in an easy lay language
15. Remains on theme largely
16. Don’t prolong unnecessarily
17. Appropriately delivers key messages on the issue
18. Takes help of the support material appropriately
19. All the key messages are delivered appropriately
20. Demonstrates the procedure appropriately (skip if NA)
21. Takes feedback on key messages appropriately
22. Takes proper feedback of the procedure (skip if NA)
23. Encourages to ask questions
24. Responds to questions appropriately
25. Clarifies appropriately where needed (skip if NA)
26. Avoids unnecessary lengthy discussion
27. Informs about sources to take help from (skip if NA)

15. Rubric
 1 = Poor
 2 = Borderline poor
 3 = Borderline satisfactory
 4 = Satisfactory
 5 = Good
 6 = Excellent
 7 = Outstanding

16. Assessment type and scoring
 Formative assessment
 Low stakes assessment
 Coupled with feedback
 Other than skip items, should meet at minimum the
satisfactory for all of the items

17. Reliability Assurance
 Items are clear
 Items are not double barreled
 Total number of items exceed 20
 Several items check for key concepts/constructs
 Training of the study team
 Pilot testing the study team and tool
 Multiple observations
 Multiple raters

18. Reliability analysis
 For internal consistency: ICC
 Inter item correlation
 Item to total correlation
 Split half reliability (Cronbach alpha)
 Test retest reliability
 For inter rater reliability: Pearson Correlation

19. Validation methods
 Face Validation: Seeking experts’ opinion
 Content validation:
1. Experts
2. Relevant literature
 Construct validation:
1. Relevant literature
2. Experts
 Consequent validation:
- Piloting, Repeated field tests

20. Minimizing Bias
 Clear items
 No double barreled items
 Appropriate phrasing of items
 Easy to follow
 Not too lengthy
 No or minimum recall items
 Training the observers; pre testing the raters and
tool at pilot

21. Ethical considerations
 Informed consent for assessment from the assessed
 Non sharing of the assessment with non concerned
ones
 Non disclosure of identity of the assessed

22. References
1. WHO / UNICEF: Alma Ata Declaration, 1978
2. UNICEF: Multiple Indicators Cluster Survey, 2008
3. UNICEF, WHO, UNESCO, UNFPA, UNDP & UNAIDS:
Facts for Life, 3rd Edition, 2002
4. WHO: Information Series on School Health,
Document No. 9 of 2001

23. Acknowledgment
 All the course faculty for facilitation throughout
 All the members of support staff for help, and
 All the course mates for active contribution to my
learning through IPs, at group work and off & on
consultation