Health and Social Literacy Intervention to Improve Maternal Health: Study Protocol for a Randomized Pre-Post Test Design with a team-building intervention for primary healthcare teams and community needs assessment

Abstract

Background: The majority of poor, illiterate women of reproductive years in Pakistan are living in underdeveloped regions and are solely dependent on free primary health services provided by the state. This project aims 1) to collect baseline health and social data, 2) to deliver a health and social literacy intervention, 3) to deliver a team-building intervention for primary-level healthcare providers, and 4) to conduct a community needs assessment. Methods: Electronic health and social data will be collected at baseline, which will be used to develop a comprehensive database and develop an index for Maternal Health and Wellbeing. A 24-month intervention will be delivered which will have 6 modules related to health and social literacy. The principal investigators will train the data collectors and intervention facilitators. Lady Health Workers will collect the electronic data and pre-post test data, and Community Social Workers will deliver the health and social literacy intervention. Cluster randomized sampling will be used to sample 6 BHUs across 6 different cities of Punjab, Pakistan. A total of 360 women will be sampled and assigned randomly to the experiment and control groups. The principal investigators will deliver the team-building intervention and conduct the community needs assessment. The participants for the latter will include doctors, nurses and community health workers; and for the former will include women from the community, women community health providers, community elders and religious leaders, and local government officials. Discussion: Pakistan is falling behind on its sustainable development goals for maternal health, mainly due to the limitations of the existing services and literacy of women. There is critical need to support understaffing of current providers by partnering them with community social workers and training them for better care delivery. Similarly, women need support for gaps in both health and social literacy. Development of an index and community needs assessment report can support better identification of environmental and socio-cultural needs in the community and to advise policy makers and stakeholders about issues wider which directly and indirectly impact women’s health.