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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 37-40

Evaluating the effectiveness of a verbal autopsy workshop: A comparative analysis of pre- and posttest


Department of Community and Family Medicine, AIIMS, Patna, Bihar, India

Date of Submission08-Aug-2020
Date of Decision21-Aug-2020
Date of Acceptance03-Apr-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Dr. Neha Chaudhary
Department of Community and Family Medicine, AIIMS Phulwarisharif, Patna, Bihar - 801 507
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_94_20

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  Abstract 

Introduction: AIIMS Delhi developed an online platform Mortality in India established through Verbal Autopsies, which ultimately provides data on the cause of death in the country. AIIMS Patna being one of the partner institutions in this initiative of AIIMS Delhi, thus, conducted a 2-day workshop of Registrar General of India supervisors with the objective to strengthen the knowledge of participants and improve their practices on writing a good narrative during verbal autopsy (VA) using a key symptom list.
Materials and Methods: A total of 32 participants attended the 2-day workshop at the Department of Community and Family Medicine, AIIMS Patna, in January 2019. A pretest questionnaire was administered before the start of the workshop and to test the improvement in knowledge of participants after attending the workshop, the same questionnaire was again administered as a posttest at the end of the workshop. Feedback of participants was also collected on a predesigned semi-structured questionnaire. The collected responses were entered in MS Excel 2010. Descriptive and inferential statistics were calculated using SPSS version 16.0 software.
Results: There was a statistically significant improvement (P < 0.001) in the mean posttest score (8.6 ± 1.2) as compared to the mean pretest score (6.1 ± 2.8). Maximum participants, i.e., 15 (46.8%), reported that filling VA forms in a narrative way was the most useful part of the workshop. All the participants, i.e., 32 (100%), strongly agreed that the workshop was appropriately organized, content of the training was relevant, they were encouraged to actively participate, and adequate material was provided.
Conclusion: Further intensive workshop with more field training and refresher training at regular intervals is expected in future.

Keywords: Cause of death, posttest, pretest, verbal autopsy


How to cite this article:
Agarwal N, Chaudhary N, Ahmad S, Pathak PK. Evaluating the effectiveness of a verbal autopsy workshop: A comparative analysis of pre- and posttest. Indian J Community Fam Med 2021;7:37-40

How to cite this URL:
Agarwal N, Chaudhary N, Ahmad S, Pathak PK. Evaluating the effectiveness of a verbal autopsy workshop: A comparative analysis of pre- and posttest. Indian J Community Fam Med [serial online] 2021 [cited 2021 Jul 25];7:37-40. Available from: https://www.ijcfm.org/text.asp?2021/7/1/37/319966


  Introduction Top


Reliable information about the cause of death (COD) is one of the most pivotal factors in the planning of health intervention besides optimal use of already scarce resources, especially in a developing country like India.[1],[2] The mortality information in India is not complete as most deaths occur outside the health system, which remains undocumented and is not captured for the medical certification of COD.[3] For the last 40 years in India, the sample registration system (SRS) is providing an estimate of annual vital statistics including the COD.[4] However, the SRS is based on a fairly representative sample spread across all over the country, and India is still lagging behind from attaining universal birth and death registration. Furthermore, assigning COD to approximately 50,000 identified annual death in the sampling units is challenging.[4] In addition, the COD ascertained under SRS is of unreliable genuineness as it is reported by any near relative at the time of registration.[5] Thus, an alternative method is the need of the hour to supplement information on mortality. Globally, verbal autopsy (VA) methods have been utilized to determine the COD, especially for low-resource settings.[6],[7] For incorporating VA into SRS of Registrar General of India Office, the apex institute AIIMS Delhi developed an online platform Mortality in India established through Verbal Autopsies (MINErVA), which ultimately provides data on COD in the country. In the VA method, close caregivers of the deceased are interviewed by RGI supervisors and the information is filled in a predesigned form. The filled form is then scanned and is reviewed by trained physicians to arrive at the COD in the form of standard international classification of diseases-10 coding.[8] AIIMS Patna being one of the partner institutions in this initiative of AIIMS Delhi, thus, conducted a 2-day workshop of RGI supervisors with objectives of strengthening the knowledge of participants and improve their practices on writing a good narrative during VA using key symptom list and to assess the effectiveness of the workshop in improving the knowledge of the participants, by comparing the pre- and posttest.


  Materials and Methods Top


A 2-day training workshop on VA was conducted for RGI officers at the Department of Community and Family Medicine, AIIMS Patna, in January 2019. Prior to the workshop, a meeting was organized with the Directorate of Census Operations, Bihar, officials to finalize the agenda for the workshop. A total of 32 participants attended the workshop and were going through the training for the first time. The workshop comprised in-house training on the 1st day followed by field training on the next day. The in-house training comprised six sessions covering the topics on VA forms, key symptoms, writing a good narrative/documentation during VA using key symptom list, communication and interviewing skills, good interviewing skills, and evaluation and critique of VA narratives and medical documents. These sessions were followed by the mock VA interviews (role play) and discussion on improving narratives. On second day, a field visit was organized for all the participants, which was followed by debriefing of the field exercise (case narration and inference) and verbal discussion on narrative features (good/ bad). With the approval from competent authorities, this study was conducted to compare the effectiveness of the training workshop among the participants. Informed verbal consent was obtained from the participants. Thereafter, a pretest questionnaire containing 15 multiple choice questions with a single correct answer covering the key points of various topics included in the session was administered before beginning the workshop. To test the improvement in knowledge of participants after attending the workshop, the same questionnaire was again administered as a posttest to all the participants at the end of the workshop on the next day. A time of 15 min was provided to every participant for filling each pre- and posttest. Participants scoring <60% marks were considered as low performance and >60% were considered as high performance. In the end, the participants were requested to provide their feedback. A predesigned semi-structured questionnaire containing both open- and close-ended questions pertaining to the most useful part of the workshop, feedback on the conduction of the workshop, was used to collect the participant's feedback. The quantitative response for feedback on the conduction of the workshop was measured on a 3-point Likert scale. Declaration of Helsinki had been followed throughout the research work.

The collected responses were entered in MS Excel 2010. Descriptive and inferential statistics were calculated using Statistical Package for the Social Sciences (SPSS Inc. , Chicago, State of Illinois, United States) version 16.0 software. The qualitative data were expressed in frequency and percentages.


  Results Top


There was a statistically significant improvement (P = 0.001) in the mean posttest score (8.6 ± 1.2) as compared to the mean pretest score (6.1 ± 2.8) [Table 1]. Further, 20 (62.5%) participants achieved >60% marks in the posttest as compared to 9 (28.2%) participants who achieved <60% marks in the pretest (P < 0.01) [Table 2]. Maximum participants, i.e., 15 (46.8%), reported that filling VA forms in a narrative way is the most useful part of the workshop followed by knowledge about symptoms and disease (9 [28.1%]), theoretical and practical aspects covered (5 [15.6%]), and interviewing technique (2 [6.2%]), whereas only 1 (3.1%) reported that queries answered in a simple way is the most useful part [Figure 1]. All the participants, i.e., 32 (100%), strongly agreed that the workshop was appropriately organized, the content of the training was relevant, they were encouraged to actively participate, and adequate material was provided [Table 3], whereas maximum participants, 31 (96.8%), strongly agreed that the resource persons were interested in making them learn. On asking gains received from the workshop, maximum (93.7%) were satisfied that their queries were solved in the training, followed by 14 (43.7%) and 12 (37.5%) mentioning that they can use the provided material and try the ideas for their fieldwork, respectively, whereas 13 (40.6%) felt that there was a reinforcement of existing ideas [Figure 2].
Table 1: Comparison of mean score achieved (n=32)

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Table 2: Pre-post evaluation categorization (n=32)

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Table 3: Feedback on conduction of workshop (n=32)

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Figure 1: Feedback reported from participants on the most useful part of the workshop

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Figure 2: Feedback on gains from the workshop

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  Discussion Top


VA method application in Minerva encompasses interview of the close caregiver of the deceased to recollect the sign, symptoms, and events preceding death followed by writing a narrative which incorporates the key symptoms. The narrative is then judged by two independent physicians to diagnose the COD. Thus, writing a good narrative is a significant prerequisite to reach a suitable and accurate diagnosis, as the latter is subjective in nature. In this context, the current workshop attempted to provide an formal learning and assessment platform for acquiring skills to conduct a VA in the field. The current study noted significant improvement in the knowledge of participants after completion of the workshop. Simultaneously, the number of participants acquiring >60% marks also increased in the posttest as compared to the pretest. Thus, this gain precisely determines that administering a pretest before the beginning of a workshop aids in increasing the concentration and keenness of the participants all along the workshop. On the other hand, the participants feel more confident by the end of the workshop which is evident by positive improvement in their posttest score. Similar to our findings, Biswas et al.[9] also concluded that perhaps the pretest increases the eagerness and curiosity to pay attention during the lecture. Also, study conducted by Uma,[10] reported that including multiple-choice questions in the pretest helps the students to focus better on key points, and posttest helps to recall the important points delivered in the lecture. A similar conclusion was noted by Mandla et al.[11] and Jayachandran et al.[12]

The strength of the current workshop was role-playing and field training which imparted “hands-on“ practice to the participants, hence ensured the active involvement of the participants which was further also acknowledged by them in their feedback. Similarly, Grip de and Pleijers[13] also mentioned in their study that combining theoretical lectures with “hands-on” training in the sessions leads to an active exchange of ideas and contributions by the participants.

The objectives of the workshop were successfully met as almost all the respondents provided positive feedback on the conduction of the workshop and maximum (93.7%) could solve their queries in the workshop. Although, few participants mentioned in the feedback that more field trainings are required so these kind of workshop in future, should be extended for two more days. Thus, the feedback from the participants not only brings satisfaction to the facilitator for their work but also yields insight into the future scope.[14]

Limitation of the study

A small number of participants in the workshop limit the generalization of the result. Moreover, a 100% positive response to some questions of the feedback points towards social desirability bias.


  Conclusion Top


The workshop was successful in imparting participants with the skills to conduct a VA in their field area. However, further intensive workshops with more field training and refresher training at regular intervals should be conducted in future.

Acknowledgment

The authors acknowledge the support of MINErVA network, AIIMS Technical Support Unit, New Delhi, India, for funding the training workshop on verbal autopsy.

Financial support and sponsorship

The workshop was funded by MINErVA network, India.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Joshi R, Praveen D, Jan S, Raju K, Maulik P, Jha V, et al. How much does a verbal autopsy based mortality surveillance system cost in rural India? PLoS One 2015;10:e0126410.  Back to cited text no. 1
    
2.
Manjunatha N, Kumar CN, Thirthalli J, Suresha KK, Harisha DM, Arunachala U. Mortality in schizophrenia: A study of verbal autopsy from cohorts of two rural communities of South India. Indian J Psychiatry 2019;61:238-43.  Back to cited text no. 2
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3.
Aleksandrowicz L, Malhotra V, Dikshit R, Gupta PC, Kumar R, Sheth J, et al. Performance criteria for verbal autopsy-based systems to estimate national causes of death: Development and application to the Indian Million Death Study. BMC Med 2014;12:21.  Back to cited text no. 3
    
4.
Palanivel C, Yadav K, Gupta V, Rai SK, Misra P, Krishnan A. Causes of death in rural adult population of North India (2002-2007), using verbal autopsy tool. Indian J Public Health 2013;57:78-83.  Back to cited text no. 4
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Krishnan A, Das DK. Mortality surveillance in India: Past, present, and future. Indian J Public Health 2019;63:163-4.  Back to cited text no. 5
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6.
Thomas LM, D'Ambruoso L, Balabanova D. Verbal autopsy in health policy and systems: A literature review. BMJ Glob Health 2018;3:e000639.  Back to cited text no. 6
    
7.
Khademi H, Etemadi A, Kamangar F, Nouraie M, Shakeri R, Abaie B, et al. Verbal autopsy: Reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran. PLoS One 2010;5:e11183.  Back to cited text no. 7
    
8.
All India Institute of Hygiene and Public Health. MINERVA: Mortality in India Established through Verbal autopsy. Available from: http://aiihph.gov.in/minerva-mortality-in-india-established-through-verbal-autopsy/. [Last accessed on 2020 Apr 03].  Back to cited text no. 8
    
9.
Biswas A, Sen S, Ray K. Reliability assessment of pre-post test questionnaire on the impact of a daylong clinical pharmacology workshop among medical professionals. Asian J Med Sci 2019;10:93-7.  Back to cited text no. 9
    
10.
Uma U. Pre class and post class tests using multiple choice questions to improve lecture method of teaching. Int J Adv Res 2018;6:648-51.  Back to cited text no. 10
    
11.
Mandla J, Shaik H, Pidigundla D, Katepogu V. Evaluation of lectures by pre & post-test MCQS. J Educ Technol Health Sci 2016;3:65-7.  Back to cited text no. 11
    
12.
Jayachandran AL, Balaji J. Introduction of pre and post lecture multiple choice questions for second year undergraduate medical students in microbiology: A technique to assess knowledge acquired from the lecture. Int J Res Med Sci 2016;4:575.  Back to cited text no. 12
    
13.
Grip de A, Pleijers A. Workshop attendance as a mode of learning: Evidence from the Netherlands. Vocations Learn 2019;12:361-85.  Back to cited text no. 13
    
14.
Domple VK. Feedback of postgraduate students about research methodology workshop. Int J Community Med Public Health 2019;6:100.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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