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Global Health Econ Sustain Clinician’s attitude toward health extension program

of HEP (Ameha et al., 2014; Assefa et al., 2019; Bilal, The EFA in the present study identified three factors
2009; Jakovljevic, et al., 2020). The findings of this study that collectively accounted for 90% of the total variance.
indicate that 90.6% of clinicians believe that the HEP Even though the lack of literature in the field makes
should continue as a government program, and 76.2% of direct comparisons challenging, some non-similar
clinicians perceive the HEP to have a positive impact on studies have reported variance closer to the findings of
community health. Given that the respondents are program the present study and are considered a good indicator
participants with firsthand knowledge, we, as authors, of model fitness (Gould et al., 2014; Winters et al.,
have confidence in these findings. Even though it was 2016). However, it is worth noting that the variance
very specific, a study found that model HEP households in the present study was nearly three times that of a
experienced a 17.7% decrease in diarrheal disease among scale measured in the United States (variance = 32%)
children under five, compared to households without HEP (VanSickle et al., 2016). To assess the reliability of the
(Tadesse et al., 2022). This further supports the notion that measurement, Cronbach’s alpha coefficient, which is
HEP is progressing toward achieving its objectives. expressed as a number between 0 and 1, is frequently
used to estimate reliability (Riley, 1969); values closer
According to the present study, individuals with degrees to one indicate that the model is well fit (Brown, 2002;
had lower average values for F1 and F2 compared to those Tavakol & Dennick, 2011). In the current study, the
with diplomas. This observation aligns with the Ethiopian internal consistency of the 54 items yielded a Cronbach’s
health system standards (Consent et al., n.d.), which state alpha coefficient of 0.96, demonstrating a high level of
that degree holders are more likely to be deployed in reliability for the measures. The measurement error of
higher-level health facilities like hospitals, leading to less the instrument was calculated to be 11%, indicating
exposure to HEP. On the other hand, diploma holders that its components are interrelated. However, this does
are usually assigned to HCs, enabling them to collaborate not guarantee that the alpha coefficient would not rise
more closely with HEWs since HPs are directly linked to if the test had more items. The literature suggests that
HCs for administrative and support purposes. As a result, sampling adequacy is considered good when the subject-
the level of clinician involvement in HEP may impact the item ratio is at least 10:1 (Husum et al., 2008). Therefore,
predictive values of the different factors. As the clinicians’ a minimum of 280 samples would have been required
exposure to HEP review meetings, HEP outreach for this study. However, the inclusion of 1,210 samples in
engagement, and home visits increased, the predicted this study exceeded this minimum requirement by four
value of F1 and F2 also increased. This finding is logical times. As a result, the high reliability observed in this
because greater exposure enables clinicians to witness study can be attributed to the large sample size used.
the skills of HEWs and understand and remember the
HEW’s typical responsibilities. When clinicians expressed 5. Conclusion
a greater willingness to work with HEWs, the predictive The tool has proven to be reliable. As a result, it is appropriate
values of F1 increased by 0.73, while the predictive values to use this tool to obtain clinician opinions for the HEP
of F2 decreased by −0.44. Given the relationship between program. Three important elements relating to HEW skills
F1 and F2, the difference in results could be attributed to and knowledge and the effect of HEP on community health
chance. were discovered through EFA. These components comply
The study’s regression analysis revealed a negative with MoH (2010) recommendations for second-generation
correlation between age and the predicted value of F2, HEPs. In this study, we found that clinician exposure to
with an estimated decrease of −0.012 as age increased. One the HEP program improved their understanding of and
possible explanation for this finding is that older clinicians attitude toward HEP. Health services benefit from clinician
are not assigned to the HEP program due to the challenging participation in HEP implementation.
nature of HEP activities, which limits their understanding
of HEP daily activities. Similarly, female clinicians had a Acknowledgments
predictive value for F2 that was 0.20 lower than that of The authors would like to express their heartfelt gratitude
male clinicians. Furthermore, married clinicians exhibited to MERQ Consultancy for funding and conducting this
a greater increase in F2 values compared to non-married study, as well as for allowing us to use the data to develop
clinicians. Moreover, nurses, midwives, and home visitors this manuscript. The study was carried out by MERQ
had higher F2 values than MDs. These findings are Consultancy PLC in collaboration with the Federal
comparable to similar studies conducted in health systems Ministry of Health. The comprehensive evaluation of the
that share a similar legacy of medical service provision and HEP, of which this study was a part, was funded by the
financing (Jakovljevic et al., 2016; Jakovljevic et al., 2021). Bill & Melinda Gates Foundation. We also thank the field

Volume 1 Issue 1 (2023) 10 https://doi.org/10.36922/ghes.0887