Reducing Infant Mortality through Community Voice

In 2008 the Center for Research on Women began work on a comprehensive, four-year evaluation of Community Voice (CV), a grassroots educational program designed to reduce and prevent infant mortality. CV is administered locally by the Tennessee March of Dimes.  The educational program and its evaluation are part of Governor Phil Bredesen's statewide Infant Mortality Initiative.  The initiative in Memphis is coordinated by the Shelby County Office of Children and Youth.

CROW is working in partnership with the UofM Center for Community Building and Neighborhood Action (CBANA) to evaluate the program's effectiveness in Shelby County.

Based on a curriculum and trainer’s guide developed by the Community Voice Program of the South Central Perinatal Council of Virginia, lay health advisors are recruited and trained to take the information they receive throughout the community.

Premised on the understanding that local, indigenous, and tacit knowledge about pregnancy and parenting motivates behavior, Community Voice is intended to diffuse new knowledge working through indigenous and credible social networks and pivotal persons in those networks.

The vision for Community Voice is that it will lead to better birth outcomes in communities where new knowledge is diffused and healthier behaviors adopted.  Better birth and maternal outcomes (lower incidence of prematurity and low birth weight,  diminished infant mortality, and other indicators that may be identified) are expected to be a moderate to longer term effect, so that while these outcomes will be baselined and tracked during the three year period, we expect to more fully document process and interim outputs.

In just one year, over 200 lay health advisors (LHAs) have been certified through the Community Voice program and those LHA's have reported sharing their new knowledge with over 2,000 people in the Memphis community.

The Evaluation Process

In this project, CROW and CBANA are using an empowerment evaluation protocol where contextual knowledge that evaluators might bring to bear as the program is being implemented is shared with program staff and volunteers, and where community-based participants share in the interpretation and fine-tuning of the evaluation process.

Evaluation components include:

Process evaluation: Participant observation and standard field methods documenting design, implementation, and acceptance of the training and other aspects of Community Voice.

Standardized pre and post-testing for training participants (knowledge, beliefs and attitudes, and intended behaviors), along with activity logs designed to document actual changes in behavior and fidelity to the diffusion concept.

Asset mapping and other contextual analysis to grasp neighborhood inputs (strengths, weaknesses, opportunities and threats) that may impinge on the successful implementation of Community Voice among particular social networks or in particular neighborhoods (risk and protective factors for successful implementation or diffusion.)

Measures of diffusion and penetration, including the activity log and perhaps other measures such as a systematic survey of network members/neighborhood residents.

Tracking birth and maternal outcomes from 2007 baseline through 2010 (with final report in 2011.)