Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol Impact on inequities in health indicators: Effect of implementing the integrated management of neonatal and childhood illness programme in Haryana, India Economic evaluation of a task-shifting intervention for common mental disorders in India. Eliciting public preference for health-care resource allocation in South Korea. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of FINALE NICE guidance on long-term sickness and incapacity. Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention Task-Shifting of Antiretroviral Delivery From Health Care Workers to Persons Living With HIV/AIDS: Clinical Outcomes of a Community-Based Program in Kenya The effect of a health promotion intervention for construction workers on work-related outcomes: results from a randomized controlled trial 'More research needed': plugging gaps in the evidence base on health inequalities. Impact of Selective Evidence Presentation on Judgments of Health Inequality Trends: An Experimental Study Is staff well-being and communication enhanced by multidisciplinary work shift evaluations? Improving care for minorities: can quality improvement interventions improve care and outcomes for depressed minorities? Results of a randomized, controlled trial. Gender involvement in manual material handling (mmh) tasks in agriculture and technology intervention to mitigate the resulting musculoskeletal disorders. Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Evaluating a Large-Scale Community-Based Intervention to Improve Pregnancy and Newborn Health Among the Rural Poor in India.
Introduction Task shifting interventions are intended to both deliver clinical ly effective treatments to reduce disease burden and address health inequities or population vulnerability . Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting . This systematic review will address the following questions : Among  task shifting interventions in high-income setting s that have been studied using r and omised controlled trials or variants , how are health inequity or population vulnerability identified and defined ? What methods and indicators are used to describe , characterise and measure the population ’s baseline status and the intervention ’s impacts on inequity and vulnerability ? Methods and analysis Studies were identified through data base search es ( MEDLINE , Embase , CINAHL , PsycINFO and Web of Science ) . Eligible studies will be r and omised controlled trials published since 2004 , conducted in high-income countries , concerning task shifting interventions to treat any disease , in any population that may face health disadvantage as defined by the PROGRESS-Plus framework ( place of residence , race/ethnicity/culture/ language , occupation , gender/sex , religion , social capital , socioeconomic position , age , disability , sexual orientation , other vulnerable groups ) . We will conduct independent and duplicate title and abstract screening , then identify related papers from the same programme of research through further data base and manual search ing . From each programme of research , we will extract study details , and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework . Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study . A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implication s. Ethics and dissemination This review does not involve primary data collection , does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures . Dissemination will include open-access peer- review ed publication and academic conference presentations . PROSPERO Registration Number CRD42017049959 Background A trial to evaluate the Integrated Management of Neonatal and Childhood Illness ( IMNCI ) strategy showed that the intervention result ed in lower infant mortality and improved infant care practice s. In this paper , we present the results of a secondary analysis to examine the effect of the IMNCI strategy on inequities in health indicators . Methods The trial was a cluster – r and omized controlled trial in 18 primary health centre areas . For this analysis , the population was divided into subgroups by wealth status ( using Principal Component Analysis ) , religion and caste , education of mother and sex of the infant .  Multiple linear regression analysis was used to examine inequity gradients in neonatal and post – neonatal mortality , care practice s and care seeking , and the differences in these gradients between intervention and control clusters . Findings Inequity in post – neonatal infant mortality by wealth status was lower in the intervention as compared to control clusters ( adjusted difference in gradients 2.2 per 1000 , 95 % confidence interval ( CI ) 0 to 4.4 per 1000 , P = 0.053 ) . The intervention had no effect on inequities in neonatal mortality . The intervention result ed in a larger effect on breastfeeding within one hour of birth in poorer families ( difference in inequity gradients 3.0 % , CI 1.5 to 4.5 , P < 0.001 ) , in lower caste and minorities families , and in infants of mothers with fewer years of schooling . The intervention also reduced gender inequity in care seeking for severe neonatal illness from an appropriate provider ( difference in inequity gradients 9.3 % , CI 0.4 to 18.2 , P = 0.042 ) . Conclusions Implementation of IMNCI reduced inequities in post – neonatal mortality , and newborn care practice s ( particularly starting breastfeeding within an hour of birth ) and health care – seeking for severe illness . In spite of the intervention substantial inequities remained in the intervention group and therefore further efforts to ensure that health programs reach the vulnerable population subgroups are required . Trial Registration Clinical trials.gov NCT00474981 ; ICMR Clinical Trial Registry OBJECTIVE To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary -care setting s in Goa , India . METHODS Cost-utility and cost-effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary -care facilities . Subjects were r and omly assigned to an intervention or a control arm . Eligible subjects in the intervention arm were given psycho-education , case management , interpersonal psychotherapy and /or antidepressants by lay health workers . Subjects in the control arm were treated by physicians . The use of health-care re sources , the disability of each subject and degree of psychiatric morbidity , as measured by the Revised Clinical Interview Schedule , were determined at 2 , 6 and 12 months . FINDINGS Complete data , from all three follow-ups , were collected from 1243 ( 75.4 % ) and 938 ( 81.7 % ) of the subjects enrolled in the study facilities from the public and private sectors , respectively . Within the public facilities , subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm . Time costs were also significantly lower in the intervention arm than in the control arm , whereas health system costs in the two arms were similar . Within the private facilities , however , the effectiveness and costs recorded in the two arms were similar . CONCLUSION Within public primary -care facilities in Goa , the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving OBJECTIVES To identify the principles the public considers important and the trade-offs between different values in health-care re source allocation practice s. METHODS This study approached the issue in both qualitative and quantitative ways . In a qualitative study , two focus groups discussed the issues of re source allocation in health care . To facilitate the discussion , a simple ranking task and a series of pairwise choice practice s were implemented . A discrete choice experiment survey question naire was also administered to a sample of the general population . Attributes and levels were determined through literature review s and the results from the focus group interview . We used a r and om-effect probit model to assess the effects of each attribute . RESULTS Through the focus group interviews , we found strong public support for the principle of equal opportunity . The participants thought that the severity of disease was the most important criterion when setting priorities . The majority supported the idea that the most disadvantaged should have the highest priority even when their health gains are less than those of others . The discrete choice experiment results showed that the severity of disease , health gains , and patients ' socioeconomic status significantly influence their choices , with each parameter having an expected sign . CONCLUSION The results showed that Koreans support not only health maximization but also equal opportunity , fair re source allocation , and e quality Background A mismatch between individual physical capacities and physical work dem and s enhance the risk for musculoskeletal disorders , poor work ability and sickness absence , termed physical deterioration . However , effective intervention strategies for preventing physical deterioration in job groups with high physical dem and s remains to be established . This paper describes the background , design and conceptual model of the FINALE programme , a framework for health promoting interventions at 4 Danish job groups ( i.e. cleaners , health-care workers , construction workers and industrial workers ) characterized by high physical work dem and s , musculoskeletal disorders , poor work ability and sickness absence . Methods / Design A novel approach of the FINALE programme is that the interventions , i.e. 3 r and omized controlled trials ( RCT ) and 1 exploratory case-control study are tailored to the physical work dem and s , physical capacities and health profile of workers in each job-group . The RCT among cleaners , characterized by repetitive work tasks and musculoskeletal disorders , aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training ( CBTr ) . Because health-care workers are reported to have high prevalence of overweight and heavy lifts , the aim of the RCT is long-term weight-loss by combined physical exercise training , CBTr and diet . Construction work , characterized by heavy lifting , pushing and pulling , the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health . At the industrial work-place characterized by repetitive work tasks , the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training , CBTr and participatory ergonomics . The overall aim of the FINALE programme is to improve the safety margin between individual re sources ( i.e. physical capacities , and cognitive and behavioral skills ) and physical work dem and s , and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group . Discussion The FINALE programme has the potential to provide evidence -based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration . Trial registration sIS RCT N96241850 , NCT01015716 and Long-term  sickness absence and incapacity benefits ( disability pension ) rates have increased across industrialised countries . Effective measures are needed to support return to work . The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness . Public health evidence was provided by research using a variety of study design s that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected , and was not limited to r and omised control trials . Where the evidence base was depleted or underdeveloped , expert witnesses were called to give their opinion on the best available evidence and emerging interventions . The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed . Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence ( mainly covering the former and also mainly examining musculoskeletal conditions ) . The analysis of evidence was restricted to descriptive synthesis . Three general themes emerged from an analysis of the studies that were more likely to report positive results : early interventions ; multidisciplinary approaches ; and interventions with a workplace component . Two further review s were undertaken , one on interventions to reduce the re-occurrence of sickness absence , which identified seven studies on lower back pain , and concluded that early intervention and direct workplace input are important factors . The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit . The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions . Practitioners should consider the impact of interventions and management options on work ability for patients of working age . Work ability should be considered a key outcome for future intervention studies Background Task shifting and the integration of human immunodeficiency virus ( HIV ) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment ( ART ) . This paper describes the development and content of an intervention involving these two strategies , as part of the Streamlining Tasks and Roles to Exp and Treatment and Care for HIV ( STRETCH ) pragmatic r and omised controlled trial . Methods : Developing the interventionThe intervention was developed following discussion s with senior management , clinicians , and clinic staff . These discussion s revealed that the establishment of separate antiretroviral treatment services for HIV had result ed in problems in accessing care due to the large number of patients at ART clinics . The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals ( ARVs ) for uncomplicated patients and the stepwise integration of HIV care into primary care services . Results : Components of the interventionThe intervention consisted of regulatory changes , training , and guidelines to support nurse ART prescription , local management teams , an implementation toolkit , and a flexible , phased introduction . Nurse supervisors were equipped to train  intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline . Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process . Discussion Three important processes were used in developing and implementing this intervention : active participation of clinic staff and local and provincial management , educational outreach to train nurses in intervention sites , and an external facilitator to support all stages of the intervention rollout . The STRETCH trial is registered with Current Control Trials IS RCT N46836853 Objectives : To assess whether community-based care delivered by people living with HIV/AIDS ( PLWAs ) could replace clinic-based HIV care . Design : Prospect i ve cluster r and omized controlled clinical trial . Setting : Villages surrounding 1 rural clinic in western Kenya . Subjects : HIV-infected adults clinical ly stable on antiretroviral therapy ( ART ) . Intervention : The intervention group received monthly Personal Digital Assistant supported home assessment s by PLWAs with clinic appointments every 3 months . The control group received st and ard of care monthly clinic visits . Main Outcomes Measured : Viral load , CD4 count , Karnofsky score , stability of ART regimen , opportunistic infections , pregnancies , and number of clinic visits . Results : After 1 year , there were no significant intervention-control differences with regard to detectable viral load , mean CD4 count , decline in Karnofsky score , change in ART regimen , new opportunistic infection , or pregnancy rate . Intervention patients made half as many clinic visits as did controls ( P < 0.001 ) . Conclusions : Community-based care by PLWAs result ed in similar clinical outcomes as usual care but with half the number of clinic visits . This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs , expediting ART rollout and increasing access to treatment while exp and ing the capacity of health care institutions in re source -constrained environments Purpose The objective of the present study is to investigate the effects of a worksite health promotion intervention on musculoskeletal symptoms , physical functioning , work ability , work-related vitality , work performance , and sickness absence . Methods In a r and omized controlled design , 314 construction workers were r and omized into an intervention group ( n = 162 ) receiving personal coaching , tailored information , and material s , and a control group ( n = 152 ) receiving usual care .  Sickness absence was recorded continuously in company records , and question naires were completed before , directly after the 6-month intervention period , and 12 months after baseline measurements . Linear and logistic regression analyses were performed to determine intervention effects . Results No significant changes at 6 or 12 months of follow-up were observed in musculoskeletal symptoms , physical functioning , work ability , work-related vitality , work performance , and sickness absence as a result of the intervention . Conclusions This study shows that the intervention was not statistically significantly effective on secondary outcomes . Although the intervention improved physical activity , dietary , and weight-related outcomes , it was not successful in decreasing musculoskeletal symptoms and improving other work-related measures . Presumably , more multifaceted interventions are required to establish significant change in these outcomes Policymakers and public health research ers have dem and ed better evidence of the effects of interventions on public health and health inequalities and have pointed to the relative absence of rigorous outcome evaluations in this area . While most of these commentators agree that health inequalities are a problem , the means of tackling them often seems to rest on poor evidential foundations . This is no longer surprising , as the problem has been well-documented and the solution probably seems clear : if there is not enough evidence , then obviously we need more ; and if the evidence is ‘ weak ’ , well , then , it just needs to be ‘ stronger ’ in future . The funding environment in the UK , at least , is supportive of the production of this new , stronger evidence , with several new funding initiatives which are aim ing to foster the production of new evaluations of public health interventions . However , it might be useful to consider further what ‘ more evidence ’ might look like ( that is , what sort of evidence is needed ) and how might it be ‘ stronger ’ than in the past and also to consider what additional challenges collecting this new evidence might bring . It is clear that evidence on the effectiveness and cost-effectiveness of public health interventions is often missing . Sometimes this is because policies are insufficiently subjected to outcome evaluation , perhaps because it is assumed that they are mostly beneficial and any positive outcomes can be taken as read . R and omized controlled trials of policies are particularly uncommon and there are a variety of real and perceived barriers to trials . This means that the public are frequently ‘ enrolled ’ in real-life policy ‘ experiments ’ without giving their explicit consent , or indeed without any real prospect of anyone learning anything substantial about the effects of those interventions . Although the experimental nature of most policies is generally unacknowledged , this is not always the Reducing health inequalities is a key objective for many governments and public health organizations . Whether inequalities are measured on the absolute ( difference ) or relative ( ratio ) scale can have a significant impact on judgments about whether health inequalities are increasing or decreasing , but both of these measures are not often presented in empirical studies . In this study we investigated the impact of selective presentation of health ine quality measures on judgments of health ine quality trends among 40 university undergraduates . We r and omized participants to see either a difference or ratio measure of health ine quality alongside raw mortality rates in 5 different scenarios . At baseline there were no differences between treatment groups in assessment s of ine quality trends , but selective exposure to the same raw data augmented with ratio versus difference ine quality graphs altered participants ’ assessment s of ine quality change . When absolute ine quality decreased and relative ine quality increased , exposure to ratio measures increased the probability of concluding that ine quality had increased from 32.5 % to 70 % , but exposure to difference measures did not ( 35 % vs. 25 % ) . Selective exposure to ratio versus difference ine quality graphs thus increased the difference between groups in concluding that ine quality had increased from 2.5 % ( 95 % CI −9.5 % to 14.5 % ) to 45 % ( 95 % CI 29.4 to 60.6 ) . A similar pattern was evident for other scenarios where absolute and relative ine quality trends gave conflicting results . In cases where measures of absolute and relative ine quality both increased or both decreased , we did not find any evidence that assignment to ratio vs. difference graphs had an impact on assessment s of ine quality change . Selective reporting of measures of health ine quality has the potential to create biased judgments of progress in ameliorating health inequalities Objective To study the implementation of multidisciplinary structured work shift evaluations at a pediatric intensive care unit ( PICU ) to enhance team communication . Design and setting Prospect i ve , repeated measurements design , comparison of pre/post measurements and process measures in a Dutch tertiary care , university-affiliated PICU . Participants All 61 PICU staff members . Interventions Implementing multidisciplinary structured work shift evaluations . Before the implementation phase the PICU team received feedback training and eight participants ( four physicians , four nurses ) were trained as “ work shift evaluation leader .  ” Measurements and results Outcome measures covered : ( a ) quality and process of the implementation through prestructured checklists during the 3 months of implementation , ( b ) a subjective evaluation of a feedback training on team communication as anticipated action and on the level of communication ( about patients and with colleagues ) , and ( c ) emotional exhaustion complaints and work-related fatigue . The interdisciplinary structured work shift evaluations were implemented successfully as planned during the work shift ; all staff were trained ahead , and the process was followed almost completely . Almost two-thirds ( 62 % ) of the staff felt a positive influence on team communication . Almost all staff members ( 92 % ) were satisfied regarding communication with their colleagues after the intervention , compared to 76 % before . Emotional exhaustion in the PICU team decreased significantly after the implementation , but no differences in work-related fatigue levels were found . Conclusions As organizational change the implementation of a multidisciplinary structured work shift evaluation at a PICU was successful and team communication improved . Emotional exhaustion decreased during the study period OBJECTIVE Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients , yet practice -based approaches to reduce such disparities have not been identified . We determined whether practice -initiated quality improvement ( QI ) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities . STUDY SETTING The sample consists of 46 primary care practice s in 6 U.S. managed care organizations ; 181 clinicians ; 398 Latinos , 93 African Americans , and 778 white patients with probable depressive disorder . STUDY DEIGN : Matched practice s were r and omized to usual care or one of two QI programs that trained local experts to educate clinicians ; nurses to educate , assess , and follow-up with patients ; and psychotherapists to conduct Cognitive Behavioral Therapy . Patients and physicians selected treatments . Interventions featured modest accommodations for minority patients ( e.g. , translations , cultural training for clinicians ) . DATA EXTRACTION METHODS Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups . PRINCIPAL FINDINGS At baseline , all ethnic groups Latino , African American , white ) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months ( by 8 - 20 percentage points ) within each ethnic group , with no significant difference in response by ethnic group . The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12 ; the white intervention sample did not differ from controls in reported probable depression at either follow-up . While the intervention significantly improved the rate of employment for whites and not for minorities , precision was low for comparing intervention response on this outcome . It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients . CONCLUSIONS Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike , while minorities may be especially likely to benefit clinical ly . Further research needs to clarify whether employment benefits are limited to whites and if so , whether this represents a difference in opportunities . Quality improvement programs appear to improve quality of care without increasing disparities , and may offer an approach to reduce health disparities The lifting and carrying of loads in agriculture on small l and holdings are unavoidable . Rural communities often lack access to appropriate technologies which may result in various health hazards . The objective was to study gender participation in agricultural activities involving manual material h and ling tasks , to assess MSDs experienced in various MMH tasks and to evaluate traditional method and design ed technology . The study was conducted on 100 agricultural workers . Data on gender participation in MMH tasks in household , animal husb and ry and agriculture and result ing MSDs was gathered . Pre and post assessment of technology intervention was done for NIOSH Lifting Index , QEC , and RPE . The results revealed greater susceptibility of females to musculoskeletal problems in most of the household and animal husb and ry tasks . The h and trucks design ed were pushing type with power grasp h and le . The respondents were advised to carry 5 kg of weight per lift instead of lifting more weight in one lift/minute while filling the h and truck . By decreasing the weight and increasing the number of lifts per minute the respondents were seen falling in green zone indicating significant reduction in NIOSH lifting index . QEC scores concluded that for filling the h and truck 5 kg of weight should be carried to keep the exposure level low Background Neonatal mortality remains unacceptably high in many low and middle-income countries , including India . A community mobilisation intervention using participatory learning and action with women ’s groups facilitated by Accredited Social Health Activists ( ASHAs ) was conducted to improve maternal and newborn health . The intervention was evaluated through a cluster-r and omised controlled trial conducted in Jharkh and and Odisha , eastern India . This aims to assess the cost-effectiveness this intervention . Methods Costs were estimated from the provider ’s perspective and calculated separately for the women ’s group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees ( VHNSC ) conducted in all trial areas . Costs were estimated at 2017 prices and converted to US dollar ( USD ) . The incremental cost-effectiveness ratio ( ICER ) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions . ICERs were calculated for cases of neonatal mortality and disability-adjusted life years ( DALYs ) averted . Results The incremental cost of the intervention was USD 83 per averted DALY ( USD 99 inclusive of VHSNC strengthening costs ) , and the incremental cost per newborn death averted was USD 2545 ( USD 3046 inclusive of VHSNC strengthening costs ) . The intervention was highly cost-effective according to WHO threshold , as the cost per life year saved or DALY averted was less than India ’s Gross Domestic Product ( GDP ) per capita . The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses . The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective . Conclusion Participatory learning and action with women ’s groups facilitated by ASHAs was highly cost-effective to reduce  neonatal mortality in rural setting s with low literacy levels and high neonatal mortality rates . This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality setting Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 Objectives . We evaluated the effectiveness of the Sure Start project , which was implemented in 7 districts of Uttar Pradesh , India , to improve maternal and newborn health . Methods . Interventions were implemented at 2 r and omly assigned levels of intensity . Forty percent of the areas received a more intense intervention , including community-level meetings with expectant mothers . A baseline survey consisted of 12 000 women who completed pregnancy in 2007 ; a follow-up survey was conducted for women in 2010 in the same villages . Our quantitative analyses provide an account of the project 's impact . Results . We observed significant health improvements in both intervention areas over time ; in the more intensive intervention areas , we found greater improvements in care-seeking and healthy behaviors . The more intensive intervention areas did not experience a significantly greater decline in neonatal mortality . Conclusions . This study demonstrates that community-based efforts , especially mothers ' group meetings design ed to increase care-seeking and healthy behaviors , are effective and can be implemented at large scale
Some research provided robust analyses of the affected population s ’ health inequities and demonstrated how a task shifting intervention redressed those concerns .
Introduction Task shifting interventions have been implemented to improve health and address health inequities .
Little is known about how inequity and vulnerability are defined and measured in research on task shifting .
We conducted a systematic review to identify how inequity and vulnerability are identified , defined and measured in  task shifting research from high-income countries .