Developing a metric for frontline worker collaboration in India's Integrated Child Development Services: A step toward measuring the "missing middle" of multi-sectoral collaboration
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Date
2019-04-04
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Johns Hopkins University
Abstract
Multi-sectoral collaboration (MSC) is widely recognized as a critical aspect of policies, programs, and interventions to address complex public health issues, yet it tends to be undertheorized and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This dissertation takes a step toward filling in this “missing middle” of MSC by developing and testing a scale-based instrument to assess collaboration between the frontline workers of one of India’s largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme. Informed by Emerson’s & Nabatchi’s Integrative Framework for Collaborative Governance, the study follows a mixed methods design for instrument development and construct validation, including a quantitative strand (Paper 1) to develop the 18-item, Likert-type scale and test its psychometric properties; a qualitative strand (Paper 2) to identify key collaboration factors among the frontline workers through in-depth interviews (IDIs) and inductive thematic analysis of transcripts; and a mixed analysis (Paper 3) triangulating the quantitative and qualitative findings to further assess the construct and content validity of the scale. Embedded within a parent study conducted in two districts of Uttar Pradesh, India, data collection involved field testing of the scale in Hindi with frontline workers in 346 villages and in-depth interviews with those workers in six purposively sampled villages. Results provide clear evidence supporting the internal consistency and validity of the frontline worker collaboration scale in the study context and serve as a proof of concept for possible adaptation of the scale elsewhere. Recommendations for scale refinement are provided, including the development and testing of two additional scale items (flexibility and locus of control). The frontline worker collaboration scale may be useful for ICDS managers as the Indian Government redoubles its efforts to strengthen and monitor MSC, or “convergence”, in the scheme, while identified collaboration factors may have implications for ICDS program management, training, and hiring. Finally, the study’s design introduces a useful adaptation of an existing mixed methods instrument development framework.
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Keywords
multi-sectoral, collaboration, frontline workers, psychometric scale, ICDS, mixed methods, health, nutrition, service delivery