Effect of Supportive Supervision Training Intervention for Community Health Assistants on Performance of Community Health Promoters in Tuberculosis Services in Mombasa County, Kenya: A Quasi-Experimental Study

Abstract

Purpose: This study examined the effect of supportive supervision training intervention for Community Health Assistants (CHAs) on Community Health Promoters’ (CHPs) performance in Tuberculosis services in Mombasa County. Tuberculosis is still a global health concern, with treatment outcomes often constrained by below par performance on community indicators. Community Health Promoters are critical in primary healthcare delivery but face challenges that limit their effectiveness.

Methodology: This was a before and after quasi-experimental design conducted in Kisauni Sub-County, Mombasa County. A sample of 210 CHPs was selected from a population of 443 using proportionate stratified random sampling, while 17 CHAs and 6 Sub-County Community Health Services Coordinators (SCCHSCs) were included through census. CHAs and CHPs participated at both baseline and endline. The intervention involved a structured two-day CHA training based on national guidelines and baseline findings, followed by six months of monthly supportive supervision using a standardized checklist integrated with a modified Behaviourally Anchored Rating Scale. Data were collected through questionnaires, supervision checklists, and Key Informant Interviews. Quantitative data were analysed using descriptive and inferential statistics. Both predictors and CHP performance were operationalised from self-reported questionnaire data, with CHP performance independently corroborated using CHAs’ supportive supervision checklists. Bivariate and multivariate analyses used the questionnaire-derived dataset, with study period (baseline vs endline) included as a predictor to assess the effect of the intervention on CHP performance. Qualitative data were analysed thematically.

Findings: Significant improvements were observed post-intervention. CHA knowledge increased (p < 0.001; Cohen’s d = 1.84). CHP performance improved across all TB service delivery indicators based on supportive supervision checklist (Wilcoxon p < 0.001; Friedman p < 0.001), and self-reported questionnaire responses (χ² p < 0.001), suggesting a strong effect of the intervention (Wilcoxon r = 0.76–0.86; Cramer's V = 0.44–0.67). The Chi-square test showed significant associations between independent variables and CHP performance (p < 0.05), with moderate to strong effect sizes (Cramer’s V = 0.332–0.66, p < 0.001). All factors were significant predictors of CHP performance in the crude analysis (cOR = 8.11–20.30, p < 0.001). The logistic regression model was statistically significant (Omnibus χ² = 299.529, df = 9, p < 0.001), with good fit (Hosmer–Lemeshow p = 0.195), high predictive accuracy (84.2%), and no multicollinearity (Tolerance = 0.291–0.689; VIF = 1.45–3.44). Significant predictors included CHP training (aOR = 2.23, p = 0.023), availability of tools and materials (aOR = 3.34, p = 0.001), frequent feedback (aOR = 2.34, p = 0.038), timely feedback (aOR = 4.72, p < 0.001), standardized M&E framework (aOR = 2.40, p = 0.009), and performance review meetings (aOR = 2.63, p = 0.005). The intervention was a strong independent predictor of CHP performance, with significantly higher odds of high CHP performance observed at endline compared to baseline (aOR = 6.01, 95% CI: 2.30–15.70, p < 0.001), indicating a positive effect after controlling for other factors.

Unique Contribution to Theory, Practice and Policy: Attachment Theory informed the study since it puts emphasis on the importance of supportive relationships in boosting confidence, motivation, and optimal functioning. In this study, the supportive supervision and structured engagement between CHAs and CHPs may have created a secure attachment that enhanced CHPs’ sense of trust, guidance, and psychological safety. The study recommends institutionalizing supportive supervision, strengthening CHA training, and ensuring adequate resources and standardized monitoring systems to sustain performance improvements.