(C) PLOS One This story was originally published by PLOS One and is unaltered. . . . . . . . . . . The use of video job-aids to improve the quality of seasonal malaria chemoprevention delivery [1] ['Susana Scott', 'Faculty Of Epidemiology', 'Population Health', 'London School Of Hygiene', 'Tropical Medicine', 'London', 'United Kingdom', 'Bienvenu Salim Camara', 'Centre National De Formation Et De Recherche En Santé Rurale De Maferinyah', 'Forécariah'] Date: 2023-01 The main challenges with using the video for training were practical (phones, power, internet, data projectors); there were concerns about language and accent of the audio narration impacting on understanding; and differences between the video and national practices with respect to details of the procedures for administering SMC drugs. If the video is used without in-person training it could be difficult to ensure everyone has participated and is able to ask questions to improve understanding. Many advantages were identified for using the video for training: the messages are clear and simple, and easy to remember, and the video conveys the same information to everyone. The video could enable training without the need to gather in-person, with benefits in saved time and cost in addition to maintaining social distancing. The videos could also potentially be used in online training. The videos can be viewed on android devices used in the field, as a job-aid providing a reminder of the delivery process both for distributors and supervisors, and as an aid to supportive supervision. In total, 52 participants from 11 of the 13 SMC countries participated in one of the two workshops held in January 2021, in English for The Gambia, Ghana and Nigeria, and in French for Benin, Burkina Faso, Cameroon, Guinea, Mali, Niger, Senegal, and Togo. Participants were staff responsible for coordination and training of SMC drug distributors. Before the workshop, all participants were sent a link to the latest version of the video, and were asked to view the video before the workshop. Workshop participants reflected on opportunities for making use of the videos during training. The video could be given to participants in advance of the training, to familiarise them with the information; face-to-face training could utilise role-plays, which could be based on situations presented in the video. Additional short videos could show challenging situations that could be used to reflect with trainees about effective ways to deal with such situations. After face-to-face training, the video is useful to remind distributors of what they need to do, as the SMC campaign can extend over 5 months, and staff or volunteers may also work on other campaigns during this period. Stills or images from the videos could be used in in-person training in areas with poor internet connectivity or lack of electricity, to demonstrate practice or stimulate debate. The videos could be used in a number of different ways: shown to trainees during in-person training or used to identify messages to be incorporated into face-to-face training, and to provide a focus for assessment of understanding. Case study in Guinea Drug distributors who watched the video stated that it reflected what they had been taught in previous training but the information in the video was easier to understand and more practically oriented than the in-person training they had received. " It’s a reminder tool, and I call it an aide-memoire that the [distributors] can use so as not to make mistakes" IDI, Regional Health Officer Supervisors felt the video could support their work, drug distributors could refer to the video in the first instance to check the procedures, without needing to ask the supervisor. "… it will also facilitate the work of the supervisors. A supervisor who has to supervise several shifts, and if this video is available [with distributors], this may decrease supervisors’ workload " IDI, SMC national supervisor Some distributors in Labé said they generally followed all the steps mentioned in the video, but many other distributors in Labé and in Siguiri acknowledged that, although they knew the correct procedures, they did not observe all the video’s recommendations. Distributors said that respecting all the steps recommended in the video was time consuming, therefore following all the steps was not practical in terms of the target number of children to cover with SMC per day. Each pair of distributors are expected to cover 80 children during an eight-hour day, which is an average of six minutes per child. The shortest time observed for a single administration was four minutes, and the longest time sixteen minutes, and these figures do not include time to move from one household to the next. The shorter administrations, were instances where the child’s caregiver accepted the SMC immediately without extended discussion, and the child was present. In longer administrations, which were the majority, either the caregivers had a long discussion with the distributors before agreeing, or the child was absent or could not take the drugs immediately (playing, sleeping or had to eat first). Given the daily targets of 80 children, distributors would often not follow all the procedures as they are time consuming. "You know that we [are taught] everything [all the recommendations] during the training, but in the field it’s different, we can’t respect everything. If you respect all the instructions, the procedures as they say in training, you’re going to delay a lot, and if you come back from the field in the evening, they’re going to scold you that you’re not working well. It’s very tricky indeed…" Informal conversation, SMC distributer, male, Labé, 13th December 2020 The procedures that should be followed to deliver SMC drugs safely during the COVID-19 pandemic, were not always followed. Adherence to these procedures was problematised in the Guinea context due to mistrust of health workers and in disbelief in the existence of the COVID-19 virus. There was widespread mistrust in Guinea of government healthcare services and workers following the 2013–2015 Ebola crisis [10,11]. This mistrust has been reactivated with the COVID-19 pandemic, and many community members do not believe in the existence of COVID-19, or its presence in their locale. Drug distributors were observed not using masks in Siguiri and a very few wearing them in Labé. Indeed, community members, especially in Siguiri, perceived the use of face mask as the signal that the COVID-19 is present, and some community members suspected distributers to spread the corona virus. It was therefore felt that requiring drugs distributors to wear face masks would be received badly and result in lower rates of take up of the SMC drugs. Some parents said they refused SMC because they did not recognise the drug distributors with a mask. "The [distributors] who came here the first time were all wearing masks. When they came, I couldn’t recognise them with the mask. I did not want to accept what them [their service] because I could not know who they are. But when the girl [one of the distributors] took off her mask, I immediately recognised her and finally, I allowed them to give the drugs" Informal conversation with a Caregiver "…I have my face mask in my packbag, but as you know it is not cautious to take it out…" Informal conversation, SMC distributor Some drug distributors found it hard to follow the guidance on social-distancing in the video, physical distancing when visiting a household, in particular towards those who are older than the distributor, can be considered disrespectful. “…people sometimes, if you distance yourself from them, they will feel offended, and it is difficult to observe social distancing; shaking hands is a much-appreciated custom and to fail to do so is to disrespect the elders” Informal conversation, SMC distributor A key aspect of the social distancing guidance was that the distributor should pass the blister pack to the caregiver, and ask them to administer the medication while observed by the distributor, rather than the usual practice which was that the distributor administers the medicine. In Guinea, distributors were advised not to let the caregivers suspect that this change was due to COVID-19. Instead they were told to explain this change so that caregivers could learn to administer the SMC whilst being observed, so that they know how to do this when they administer the remaining doses unsupervised on each of the next two days. “We said again, we must not tell the parents that we ourselves do not give the medication because there is Covid-19, that we must not say that. That we must say, as we do every year, so you are going to distribute this time, we will see if you have understood how we do it.” SMC Drug distributor Distributors were issued with alcohol-based hand rubs, or ‘gel’ rather than needing to use soap and water, but were advised to use the gel out of sight of the community. The video showed distributors asking for soap and water to wash their hands, but in Guinea this could be considered impolite especially if asking an older member of the household. Some distributers therefore preferred not to ask, and so did not wash their hands before providing the SMC drugs. The video was adapted to remind the drug distributors to wash their hands at the start but the instruction to ask households to provide soap and water was omitted. This allowed the drug distributors to choose how best to clean their hands in a given context. [END] --- [1] Url: https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000165 Published and (C) by PLOS One Content appears here under this condition or license: Creative Commons - Attribution BY 4.0. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/plosone/