health information tools. Staff also discussed the need to build stronger relationships with communities to work together to spread health-promotion messages. Patients echoed these desires for additional education and greater connection to the clinics. “Maybe the government could provide training for our community leaders such as our local chief or leader, counsellor, reverends, etc. about health issues and that they can provide support because they are well known, respected, trusted, and supported by the community....health information such as pamphlets that we get from the district are not enough. We want to teach the community, but we can’t. Sometimes the pamphlets are written in English, and some of our community members cannot read English. We also do not have health promoters who will go around the community to distribute this information to the community. We only do that once a month, so maybe if we had health promoters, they could plan more awareness days and help us provide more services. So, information is key, the community needs to be taught so they can know what is expected from them.” – Frontline caregiver “I would like the clinics to teach people about chronic sickness, everyone not just us so that people will not panic, so that they will know what to do next and they should also encourage people to go test at the clinics, they shouldn’t be afraid to test for any type of sickness, even if they are not sick.” – Patient
Comparison facilities and baseline
Patient focus group discussions and staff interviews at comparison facilities echoed many of the same themes described above and overall, responses from the two groups of participants were very similar. The same challenges were raised and many of the same ideas were presented to improve community health and quality of care. While there were many complaints about infrastructure in intervention facilities, these complaints were slightly more escalated in comparison facilities, with staff mentioning major sewage problems and lack of water and electricity. Staff in comparison facilities were more likely than those in intervention sites to describe outreach activities and adherence clubs as part of the core work of the facility. Themes arising from the endline interviews and focus group discussions align with key findings from baseline data collection. At baseline, the key barriers to care identified were transportation, staff shortages, wait times, and missing equipment, all of which were confirmed at endline. Patients’ concerns about confidentiality when speaking to health workers were also expressed at both baseline and endline.
United States Quantitative Rice County
Diabetes cascade of care. HealthFinders showed some improvements in terms of the percentage of patients meeting treatment targets since baseline (Figure 48), with 43.5% (95% CI: 33.6–53.9%) of patients with A1c levels lower than 8% at baseline and 50.0% (95% CI: 39.7–60.0%) at endline. Patients in the comparison group had somewhat higher levels of diabetes control at both baseline and endline than HealthRise patients; however, due to overlapping confidence intervals, these were statistically indistinguishable differences. For both HealthRise and comparison patients, about 25% saw decreases in A1c that equaled or exceeded 10% since baseline measurements. Male HealthRise patients showed moderate improvement in diabetes control since baseline (Figure 49), though these changes were not statistically significant (i.e., 39.0% [95% CI: 24.9–55.2%] controlled at baseline to 51.2% [95% CI: 35.7–66.6%] at 101
