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Health Workers' Voices in Open, Inclusive Communities and Effective Spaces (VOICES)

Health Workers’ Voices in Open, Inclusive Communities and Effective Spaces (VOICES) includes 83 items related to motivation of health workers. The social accountability measure evaluates CARE’s Community Score Card approach to health workers empowerment using items adapted from CARE USA's WE-MEASR scales. The items measure health workers' perception of their surrounding environment through four aspects: self-efficacy to improve performance and quality of health services, social cohesion and collective efficacy, perceptions of service quality and service efficacy, and knowledge and awareness of rights (both patients’ rights and their own).

Categories

Geographies Tested: Malawi

Populations Included: Female, Male

Age Range: Adults

Items:

Knowledge & Awareness of Rights
 1. Women have the right to get family planning services without their husband’s permission.
 2. Patients must accept treatment if the health workers tell them they need it.
 3. Adolescents do NOT have the right to obtain family planning services.
 4. Patients have a right to complain about the quality of health services they receive.

As a healthcare provider,…
 5. …I have a right to have the equipment and supplies I need to do my job.
 6. …I can’t really expect to have clear working hours and rest periods.
 7. …I have a right to file a complaint if I feel I am not being treated with respect by my employer.
 8. …I have a right to yell at a woman if she does not listen to me.
 9. The government of Malawi ensures that maternal and child health services are provided free of charge.
 10. Community health workers should visit pregnant women and new mothersbabies at home.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Self-Efficacy for Participation
How sure are you that you can…
 11.…speak up in community or health facility meetings about things that need improvement in your health facility or catchment area?
 12.…ask people in the community what health services their community needs?
 13.…answer questions and share information with the community about the health services that are available?

Response Options:
5-point Likert scale
Completely sure - 5
Not at all sure - 1

Outcome Expectation for Participation
 14. It is important for health officials to share information with the community on services available, funding, and plans.
 15. I do NOT have enough time to participate in community meetings.
 16. Quality improvement efforts at work do NOT usually succeed.
 17. I would NOT feel comfortable having my work monitored by members of the community.
 18. I feel good when I am able to respond to community concerns about health services in this area.
 19. If the community is involved in quality improvement efforts, these efforts are more likely to be successful.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Self-Efficacy for Delivering Quality Health Services
How sure are you that…
 20.…you can do things to improve your own performance at work?
 21.…you personally can do things to contribute to improving the quality of services in your health facility or catchment area?

Response Options:
5-point Likert scale
Completely sure - 5
Not at all sure - 1

Maternal, Child, Newborn Health (MNCH) Service Efficacy
 22. Getting a health check during pregnancy is important for a healthy pregnancy.
 23. Delivering a baby at home is just as safe as delivering a baby at a health facility.
 24. Exclusive breastfeeding for the first 6 months of life (no water or other liquids) is the best thing for a baby’s teeth.
 25. It is important for a woman and her baby to get checked within 1 week of delivery.
 26. All pregnant women should get tested for HIV so they can prevent infection of their babies.

It is important for…
 27.…women to understand danger signs during pregnancy & childbirth so that they can seek care immediately.
 28.…pregnant women to think about what method of contraception they want to use after the baby is born.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Service Quality
At this health facility,…
 29.…men are welcome to accompany their wives during pregnancy care.
 30.…a family member or friend is welcome to accompany a woman during pregnancy.
 31.…patients expect to wait a long time for services.
 32.…women are left unattended for long periods during labor & delivery.
 33.…patients’ private information is kept safe & not shared with others.
 34.…health workers treat patients with respect.
 35.…adolescents feel comfortable asking for family planning services.
 36.…the health facility is clean.
 37.…health facility staff are present & available during official working hours.
 38.…patients expect to get high quality health services.
 39.…health workers sometimes yell at pregnant women from coming to the health facility for delivery too late.
 40.…there are frequent stock outs of needed drugs & supplies.
 41.…staff members do not feel comfortable speaking up if they see a problem with care provided.
 42.…skilled staff members are available to provide delivery care 24 hours a day, 7 days a week.
 43. I would feel comfortable with the quality of care as a patient at this facility.
 44. I would not recommend that my friend or relative come to this health facility [NAME] to deliver a baby.*

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Collective efficacy (health workers alone)
 45. How sure are you that health workers in this areahealth facility can work together to improve health services for women & children?

Response Options:
5-point Likert scale
Completely sure - 5
Not at all sure - 1

Supervision
How often do you…
 46.…meet with you supervisor?
 47.…review & discuss your work with your supervisor?
 48.…report on your work to your supervisor?

Response Options:
Weekly - 5
Monthly - 4
Quarterly - 3
Annually - 2
Never - 1

Supervisor’s Appreciation
My supervisor…
 49.…appreciates my efforts to do a good job.
 50.…does not take my recommendations for improvements at work seriously.
 51.…does hisher best to make sure I have everything I need to be successful at my job.
 52.…encourages me to work on things that will improve the quality of care in our area.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Work Attachment & Satisfaction
 53. My family is proud of the work I do.
 54. This work takes away too much time from my family.
 55. I really like my job.

I do not have…
 56.…the equipment & materials to do my job well.
 57.…as much control over my work as I would like to have.*

I have…
 58. …access to all the information that I need to do my job well.
 59. …regular access to someone I can go to for help when I need it to do my job well.

 60. I am recognized for my good performance with awards or other compensation.
 61. If I complain about my working conditions, I might lose my job.*
 62. I would do something else if I thought I could get another job.*
 63. I receive regular and reliable payment for my work.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Social Cohesion
 64. I cannot rely on the people I work with to give me advice.*
 65. I can rely on the people I work with to help me out with a difficult patient.
 66. Oftentimes there is conflict among the people I work with.
 67. I enjoy the people I work with.
 68. In general, the people I work with only worry about themselves.*

I can rely on the people I work with to…
 69. …stand up for me if I point out a problem at work.
 70. …support me when I try to improve my performance at work.
 71. I can trust the majority of people I work with.
 72. In general, the people I work with get along well.

The people I work with…
 73.…will resent me if I try to do things to improve the quality of care in this areafacility.*
 74.…treat me with respect.

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

Attitudes towards Patients
 75. My patients really appreciate my help.
 76. I should NOT have to provide reproductive health service to unmarried women and girls.*
 77. People in the community do NOT appreciate my efforts to provide services in the community.*
 78. Patients should expect everything they say to me to be kept private.
 79. I get frustrated when a woman in this community chooses to deliver her baby at home.*
 80. Men in this community want to support their wives when they are pregnant.
 81. People in the community are willing to do whatever they can do to improve the health of the women and children here.
 82. Health workers know what services the community needs most.*
 83. Patients are often to blame for their poor health outcomes.*

Response Options:
5-point Likert scale
Strongly agree - 5
Strongly disagree - 1

*Items are reverse coded

Scoring Procedures

Knowledge & Awareness of Rights: Item scores are summed and divided by number of items to obtain a total score.

Self-Efficacy for Participation: Item scores are summed and divided by number of items to obtain a total score.

Outcome Expectation for Participation: Item scores are summed and divided by number of items to obtain a total score.

Self-Efficacy for Delivering Quality Health Services: Item scores are summed and divided by number of items to obtain a total score.

MNCH Service Efficacy: Item scores are summed and divided by number of items to obtain a total score.

Service Quality: Items 1 through 15 are summed and divided by 15 to obtain a total score. The other item is not included in the total score.

Collective efficacy (health workers alone):The item is scored individually..

Supervision: Items are scored and summed.

Supervisor’s Appreciation: Item scores are summed to obtain a total score.

Work Attachment & Satisfaction: Items 1 through 9 are summed and divided by 9 to obtain a total score. The other items are not included in the total score.

Social Cohesion: Item scores are summed and divided by number of items to obtain a total score.

Attitudes towards Patients: Item scores are summed and divided by number of items to obtain a total score.

Original Citation

Sebert Kuhlmann, A. K., Gullo, S., Galavotti, C., Grant, C., Cavatore, M., & Posnock, S. (2017). Women's and Health Workers' Voices in Open, Inclusive Communities and Effective Spaces (VOICES): Measuring governance outcomes in reproductive and maternal health programmes. Development Policy Review, 35(2), 289-311. https://doi.org/https://doi.org/10.1111/dpr.12209

Psychometric Score

Citation Frequency

Ease of Use Score

Formative Research

Qualitative Research

Existing Literature/Theoretical Framework

Field Expert Input

Cognitive Interviews / Pilot Testing

Reliability

Internal

Test-retest

Interrater

Validity

Content

Face

Criterion (gold-standard)

Construct

Ease of Use

Readability

Scoring Clarity

Length

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