Reminders

The major assumption underlying reminder interventions is that provider forgetfulness and lack of awareness are major barriers to performance in accordance with standards, as opposed to deficiency in knowledge or skill. Reminders consist of prompts either before or during a client or patient encounter to suggest that a specific behavior should or should not be performed. The reminder may consist of a checklist, wall poster, flowchart, or other paper-based job aid that guides the health worker through the appropriate steps in a process.

Several systematic reviews have concluded that reminders have been proven effective in increasing provider adherence to preventive care standards and prescribing guidelines. The effects of reminders often disappeared after the reminders were stopped, suggesting that to be effective, reminders must be applied continuously and incorporated into daily routines (Marquez 2001).

Job aids are a type of reminder and have been widely used in developing country settings, especially with community health workers (Knebel 2000). Job aids are visual tools used by the provider during a health care activity that give direction on what actions to take and how. The purpose of the job aid is to reduce the amount of recall necessary to correctly perform the task. Job aids are thought to be most appropriate when provider forgetfulness or lack of recall is an important barrier to performance, such as when the task to be performed is complex or infrequent.

Studies by the USAID-funded Quality Assurance Project (QAP) in Benin (Jennings et al. 2010), Niger (Edson et al. 2004), Uganda (Kerstiƫns et al. 2004), and Zambia (Harvey et al. 2008) found that job aids could be feasible and effective in hospital, primary care and community settings to prompt health workers and community volunteers to perform key tasks or communicate specific messages during patient counseling. In addition, job aids can contribute to help shift tasks from higher skilled to lower skilled health workers (Jennings et al. 2011).