How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India

Figures & data

Table 1 Role of supervisees and supervisors in RI session

Type of role	Role of supervisee	Role of supervisor
Organizing sessions	• Finalizing the beneficiaries’ list • Mobilizing beneficiaries • Indenting vaccines, drugs and other logistics • Organizing the fixed monthly RI outreach sessions	Ensure sessions are conducted as per the plan Make supervisory visits to sessions
Service delivery	• Primary Immunization • Boosters • Tetanus toxoid for Pregnant women • Vitamin A supplementation • IFA supplementation • Deworming	Monitor Hand-holding support Problem solving Fact-finding and validation
Health education	• Imparting education on a specific health topic through group counseling • Addressing individual health issues through individual counseling	Make supervisory visits Ensure that complete and accurate messages are given Provide need-based guidance
Reporting	• Preparing session-wise reports • Submitting reports to the supervisor	Collect and analyze reports Provide feedback

Table 2 Knowledge and attitude of supervisors in IDs and CDs

Attributes	ID N=72	CD N=39	Sig.
Motivating supervisee is an important function of RI supervision	4.53	4.90	0.000
Punishment is sometimes required during supportive supervision	1.99	1.85	0.05
Seeking information from the supervisee is important for problem solving	4.33	4.51	0.369
Supervision is important to improve supervisee's performance	4.43	4.85	0.000
Supervision provides information for planning at all levels	4.25	4.51	0.715
Relevant new information on RI should not be given directly to the health worker during supervision	2.69	3.08	0.234
All mistakes should be immediately pointed out to the ANM in the presence of community members during the session	2.07	1.62	0.869

ID: intervention district; CD: control district; RI=routine immunization; ANM=auxiliary nurse and midwife.

For all the items mentioned in the table, the Likert scale ranged from 1 to 5, where 1=strongly disagree and 5=strongly agree.

Table 3 Practice of supervisors in intervention and control districts

Attributes	ID N=72	CD N=39	Sig.
Do you give prior information to health workers before you visit supervision?	2.38	1.85	0.059
Do you undertake revisits to supervise the same health worker?	2.13	2.08	0.131
Do you find out and visit the priority blocks?	2.22	2.36	0.466

For all the items mentioned in the table, the Likert scale ranged from 1 to 3, where 1=rarely, 2=sometimes, and 3=usually.

Table 4 Supervisors’ problem-solving skills on hypothetical situations

Attributes	Type of district	N ^a	Mean desirable response	Std. deviation	Std. error mean
What if fully melted icepacks are found?	ID	72	1.1	0.858	0.101
	CD	39	1.54	0.884	0.142
Is waster disposed at session site?	ID	69	1.17	0.804	0.097
	CD	39	0.95	0.759	0.122
Is ANM not returning unused vials?	ID	72	0.75	0.687	0.081
	CD	39	0.87	0.57	0.091
Is ANM injecting DPT in the gluteal region?	ID	72	1.79	1.404	0.165
	CD	39	0.77	0.986	0.158
Has the ANM not mentioned reconstitution time?	ID	72	1.26	1.061	0.125
	ID	39	0.95	0.857	0.137
Is ANM not giving four key messages?	ID	72	1.99	1.204	0.142
	CD	39	2.31	1.195	0.191
Is ANM touching needles?	ID	72	1.39	0.881	0.104
	CD	39	1.05	0.759	0.122
Are skills among functionaries adequate?	ID	72	1.5	1.035	0.122
	CD	39	0.92	0.739	0.118
Is ANM putting cut syringes in red bag?	ID	71	1.11	1.45	0.172
	CD	39	2.62	1.016	0.163
Is correct dose of Hepatitis B given?	ID	70	1.63	1.505	0.18
	CD	25	1.04	1.369	0.274
Is ANM attending session late?	ID	71	0.62	0.763	0.091
	CD	32	0.91	1.118	0.198
Is ANM photocopying the passbook?	ID	63	1.03	1.015	0.128
	CD	38	1.53	1.202	0.195

ID=intervention district; CD=control district.

^a N has been computed after excluding non-responses.

Table 5 Independent samples test on supervisors’ knowledge and practices^a

	Levene's test for equality of variances		t-test for equality of means
Attributes	F	Sig.	t	df	Sig. (2-tailed)
What if fully melted icepacks are found?	1.349	0.248	−2.559	109	0.012
Is waster disposed at session site?	0.654	0.42	1.427	106	0.157
Is ANM not returning unused vials?	4.218	0.042	−0.944	109	0.347
Is ANM injecting DPT in the gluteal region?	39.919	<0.001	4.038	109	<0.001
Has the ANM not mentioned reconstitution time?	6.205	0.014	1.593	109	0.114
Is ANM not giving four key messages?	0.985	0.323	−1.346	109	0.181
Is ANM touching needles?	9.823	0.002	2.02	109	0.046
Are skills among functionaries adequate?	20.21	<0.001	3.08	109	0.003
Is ANM putting cut syringes in red bag?	41.555	<0.001	−5.74	108	<0.001
Is correct dose of Hepatitis B given?	13.895	<0.001	1.717	93	0.089
Is ANM attending session late?	3.849	0.053	−1.517	101	0.132
Is ANM photocopying the passbook?	8.7	0.004	−2.211	99	0.029

^aEqual variance assumed.

Table 6 Ranking by supervisees on program skills of supervisors in IDs and CDs

		Intervention category
Process indicators of supportive supervision		ID (N=72) number (%)	CD (N=39) number (%)	Total (N=111) number (%)
Number of supervisory visits in the past 6 months	Once	15 (22.2)	18 (46.2)	34 (30.6)
	Two to three times	28 (37.5)	7 (17.9)	34 (30.6)
	More than three times	29 (40.5)	14 (35.9)	43 (38.7)
Type of communication	One way	22 (30.6)	9 (23.1)	31 (27.9)
	Two ways	50 (69.4)	30 (76.9)	80 (72.1)
Checklist availability	Yes	50 (69.4)	32 (82.1)	82 (73.9)
	No	22 (30.6)	7 (17.9)	29 (26.1)

ID: intervention district; CD: control district.

Table 7 Ranking by supervisees on knowledge, attitude, and problem-solving skills of supervisors

		Intervention category		Total (N=111)	Mean
Process indicators of supportive supervision		ID (N=57)^a number (%)	CD (N=21)^b number (%)	number (%)	ID	CD	Sig.
Attitude of supervisor	Not applicable	15 (20.8)	18 (46.2)	33 (29.7)	1.93	2.14	0.16
	Good	9 (12.5)	5 (12.8)	14 (12.6)
	Very good	43 (59.7)	8 (20.5)	51 (45.9)
	Excellent	5 (6.9)	8 (20.5)	13 (11.7)
Knowledge of supervisor	Not applicable	15 (20.8)	18 (46.2)	33 (29.7)	2.74	3	0.144
	Poor	1 (1.4)	0	1 (0.9)
	Good	19 (26.4)	6 (15.4)	25 (22.5)
	Very good	31 (43.1)	9 (23.1)	40 (36.0)
	Excellent	6 (8.3)	6 (15.4)	12 (10.8)
Problem-solving skills	Not applicable	15 (20.8)	18 (46.2)	33 (29.7)	2.53	3	0.009
	Poor	1 (1.4)	0	1 (0.9)
	Good	28 (38.9)	7 (11.9)	35 (31.5)
	Very good	25 (34.7)	7 (17.9)	32 (28.8)
	Excellent	3 (4.2)	7 (17.9)	10 (9.0)

ID: intervention district; CD: control district.

^a15 not applicable in IDs.

^b18 not applicable in CDs.

Table 8 Ranking by supervisees on the management skills of supervisors in IDs and CDs

		Intervention category		Total (N=111)	Mean
Process indicators of supportive supervision		ID (N=57)^a number (%)	CD (N=21)^b number (%)	number (%)	ID	CD	Sig.
Body language of supervisor	Responsive	44 (61.1)	27 (69.2)	71 (64.0)	2.6	2.64	0.68
	Reflective	27 (37.5)	10 (25.6)	37 (33.3)
	Fugitive	1 (1.4)	2 (5.1)	3 (2.7)
Communication process	Authoritative	1 (1.4)	3 (7.7)	4 (3.6)	3.65	3.36	0.04
	Supportive	52 (72.2)	21 (53.8)	73 (65.8)
	Friendly but not supportive	17 (23.6)	13 (33.3)	30 (27.0)
	Not involved	2 (2.8)	2 (5.1)	4 (3.6)
Process of correction	Fault finding	15 (20.8)	3 (7.7)	18 (16.2)	2.51	2.49	0.918
	Non-explanatory	8 (11.1)	5 (12.8)	13 (11.7)
	Supportive	26 (36.1)	14 (35.9)	40 (36.0)
	Does not react	23 (31.9)	15 (38.5)	38 (34.2)
	Any other	0	2 (5.1)	2 (1.8)

ID: intervention district; CD: control district.

^aNot applicable=15 in IDs.

^bNot applicable=18 in CDs.