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Table 4 Emphases from the theoretical review and formative research that support the key components of the technology intervention

From: Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda

Technology intervention
Intervention component Way in which intervention will improve CHW motivation
Theory Formative research
Uganda Mozambique
Closed user groups Potentially stimulate a feeling of shared experience and collective identity among CHWs. Considered feasible and acceptable by Ministry of Health personnel
Phone as a signifier of role—may increase the status and standing of CHWs in their community
Increase ease of communication with supervisors and promote a sense of connectedness to health system
Specifically, by promoting interaction with peers and supervisors, CHWs may: Aid prompt CHW reporting of stock outs and other challenges
No need for CHWs to use own phone—cost saving plus potential to earn from solar charger
CHWs already meet informally so formalises an existing structure that is valued
• Gain a greater sense of the correspondence between CHW goals and those of the programme Need for guidance on who initiates calls as CHWs can find unscheduled calls stressful Concerns around supervisor workload led to recommendation that supervisors be available for contact at certain times only potentially leading to the provision of more efficient and targeted feedback through managing supervisor workload
• Understand the value of achieving programme goals to the community and CHW collective
• Understand and normalise positive, appropriate and distinguishing actions of ‘good’ CHWs
CHW electronic data submission and feedback and targeted supervision Through targeted feedback delivered by supervisors: Feeling valued and linked to the health system
Feeling encouraged by positive local gains/improved community health and their role
• Gain a greater sense of the correspondence between own goals and those of the programme • Understand and normalise positive, appropriate and distinguishing actions of good CHWs • Promote realistic actions of CHWs that are within their power to deliver Strong desire among CHWs for feedback and more supervision—targeted supervision welcome
Concerns about supervisor speed of responsiveness—needs to be sufficiently prompt to avoid CHW discouragement Tone of messages key with need for polite and respectful language emphasised in order to be motivating with no admonishments for poor performance
Monthly motivational SMS Through contextually appropriate and regular messages: Positive, encouraging, polite and respectful tone with emphasis on the value CHWs bring to their community
Important to feel valued, supported and linked to the health system
• Promote the correspondence between CHW goals and those of the programme Receiving messages that are locally relevant and address key challenges promotes a sense of CHW relevance and importance to the health system
If the message resonates with data submitted, then will be perceived as performance-related feedback which was considered motivating by CHWs  
• Promote the shared experience of CHWs
• Promote the value of achieving programme goals to the CHW collective
• Validate and normalise positive, appropriate and distinguishing actions of ‘good’ CHWs
• Promote realistic actions of CHWs that are within their power to deliver