Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0007
J. V. Henry
Mobile phones help move training programmes out of the classroom and into community settings where CHWs live and work. This chapter examines what happens to ‘learning’ when training becomes ‘mobile’. To explore this, an analysis of a three-year intervention to train 90 Kenyan CHWs is drawn from science and technology studies (STS). It is argued that when a mobile learning application is deployed in an informal urban settlement and an isolated rural village, its movement makes it available for many more uses than is originally envisioned. These varied uses subject the CHWs to multiple definitions of what it means to learn and conflicting visions of how learning leads to social change. The chapter ends with a discussion of how power circulates through global health policies, mobile devices, CHWs, and the material conditions of extreme poverty to generate controversies over what knowledge matters most for health worker training programmes, and for the broader aims of international development.
{"title":"Mobile Phones and the Uses of Learning in a Training Intervention for Kenyan Community Health Workers","authors":"J. V. Henry","doi":"10.1093/oso/9780198866244.003.0007","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0007","url":null,"abstract":"Mobile phones help move training programmes out of the classroom and into community settings where CHWs live and work. This chapter examines what happens to ‘learning’ when training becomes ‘mobile’. To explore this, an analysis of a three-year intervention to train 90 Kenyan CHWs is drawn from science and technology studies (STS). It is argued that when a mobile learning application is deployed in an informal urban settlement and an isolated rural village, its movement makes it available for many more uses than is originally envisioned. These varied uses subject the CHWs to multiple definitions of what it means to learn and conflicting visions of how learning leads to social change. The chapter ends with a discussion of how power circulates through global health policies, mobile devices, CHWs, and the material conditions of extreme poverty to generate controversies over what knowledge matters most for health worker training programmes, and for the broader aims of international development.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"245 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115638077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0006
S. Nagraj
Technology-enhanced learning (TEL) is well established as a teaching modality. However, there is a lack of evidence for the pedagogical approaches used to design TEL for community health workers (CHWs). This chapter highlights the importance of contextualizing CHW learning within the wider health system. Theoretical approaches to consider when designing a TEL-based education and training programme for CHWs are presented, with practical examples of how these approaches might be most appropriately embedded in the delivery of CHW training. Finally, a framework for the design of pedagogically-grounded TEL-based learning for CHWs is presented, which may be used to help guide the design of TEL-based educational interventions for CHWs.
{"title":"Designing Pedagogically-Driven Approaches to Technology-Enhanced Learning for Community Health Workers","authors":"S. Nagraj","doi":"10.1093/oso/9780198866244.003.0006","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0006","url":null,"abstract":"Technology-enhanced learning (TEL) is well established as a teaching modality. However, there is a lack of evidence for the pedagogical approaches used to design TEL for community health workers (CHWs). This chapter highlights the importance of contextualizing CHW learning within the wider health system. Theoretical approaches to consider when designing a TEL-based education and training programme for CHWs are presented, with practical examples of how these approaches might be most appropriately embedded in the delivery of CHW training. Finally, a framework for the design of pedagogically-grounded TEL-based learning for CHWs is presented, which may be used to help guide the design of TEL-based educational interventions for CHWs.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116951429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0008
D. Musoke
Community health workers (CHWs) are a key human resource for health, particularly in low and middle-income countries. Participatory training approaches for CHWs are increasingly important as they actively engage participants, facilitate shared learning, and are more responsive to the needs of the learners. In addition, participatory training methods build teamwork and confidence, enhance critical thinking, and are interesting to learners. This chapter presents different participatory training methods for CHWs, including role-plays, demonstrations, songs, small and large group discussions, brainstorming, debates, simulations, exercises, field trips, gallery walks, class presentations, practicals, case studies, and interactive exercises. The relative advantages and disadvantages of each method are also presented. Despite the strengths and weaknesses of each of the methods, it is important that the local context is always considered while selecting which ones to be used in a CHW training programme.
{"title":"Using Participatory Approaches for Community Health Worker Training","authors":"D. Musoke","doi":"10.1093/oso/9780198866244.003.0008","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0008","url":null,"abstract":"Community health workers (CHWs) are a key human resource for health, particularly in low and middle-income countries. Participatory training approaches for CHWs are increasingly important as they actively engage participants, facilitate shared learning, and are more responsive to the needs of the learners. In addition, participatory training methods build teamwork and confidence, enhance critical thinking, and are interesting to learners. This chapter presents different participatory training methods for CHWs, including role-plays, demonstrations, songs, small and large group discussions, brainstorming, debates, simulations, exercises, field trips, gallery walks, class presentations, practicals, case studies, and interactive exercises. The relative advantages and disadvantages of each method are also presented. Despite the strengths and weaknesses of each of the methods, it is important that the local context is always considered while selecting which ones to be used in a CHW training programme.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129938032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This chapter outlines how taking a more systematic approach to developing responsive evidence bases that can inform research, policy, and practice on community health worker (CHW) training in low and middle-income countries (LMICs) supports the provision of more effective and equitable CHW programmes. It also explores methodologies and tools to develop such evidence bases and how these can and have been used to inform decision-making. We argue that by focusing on single primary studies rather than the combined body of evidence, research and practice on the training of CHWs in LMICs is overlooking systemic patterns in the evidence base. Decisions on which types of training programmes to implement in LMICs are often based on single evaluations of programmes conducted out of context or informed by general principles for workplace-based learning. Better matching research and practice needs with the available evidence base will facilitate a more effective translation of knowledge on the training of CHWs into practice and policy decisions.
{"title":"The Danger of a Single Study","authors":"Promise Nduku, Nkululeko Tshabalala, Moshidi Putuka, Zafeer Ravat, Laurenz Langer","doi":"10.1093/oso/9780198866244.003.0009","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0009","url":null,"abstract":"This chapter outlines how taking a more systematic approach to developing responsive evidence bases that can inform research, policy, and practice on community health worker (CHW) training in low and middle-income countries (LMICs) supports the provision of more effective and equitable CHW programmes. It also explores methodologies and tools to develop such evidence bases and how these can and have been used to inform decision-making. We argue that by focusing on single primary studies rather than the combined body of evidence, research and practice on the training of CHWs in LMICs is overlooking systemic patterns in the evidence base. Decisions on which types of training programmes to implement in LMICs are often based on single evaluations of programmes conducted out of context or informed by general principles for workplace-based learning. Better matching research and practice needs with the available evidence base will facilitate a more effective translation of knowledge on the training of CHWs into practice and policy decisions.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"135D 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134599333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0005
B. Wasunna, I. Holeman
According to the World Health Organization’s No Health Without a Workforce report, the global shortage of community health workers (CHWs) is expected to reach 12.9 million by 2035. This shortfall raises pressing questions about how CHWs are recruited, trained, and supported as front-line care providers. Lay people become CHWs in a variety of ways; they might be chosen by a non-governmental organization or a government programme, elected by community members, or simply volunteer themselves at the right time and place. After recruitment, CHWs typically undergo training, and the scope and quality of this training can vary enormously. Often, limited funds are stretched to conduct trainings in person at facilities that may or may not be readily accessible for health workers, and refresher trainings are often cut in times of budget shortfall. While there may be no simple solution to these challenges, many now look to the use of digital technologies as a promising opportunity. Digital health interventions have come to play a growing role in healthcare in the last decade, yet the uses of technology for training, ongoing education, and supportive supervision remain understudied in lower-income settings. In this chapter, we examine a case study of digital health interventions in Nepal. We examine matters of baseline literacy and access to technology, the interweaving of technology and health system design issues, and prospects for integrating digital and face-to-face education and support. While the role of technology is easily overstated, we nonetheless argue that new digital workflows can address real implementation challenges if designed in a human-centred manner.
{"title":"Digital Health Interventions for Community Health Worker Training, Ongoing Education, and Supportive Supervision","authors":"B. Wasunna, I. Holeman","doi":"10.1093/oso/9780198866244.003.0005","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0005","url":null,"abstract":"According to the World Health Organization’s No Health Without a Workforce report, the global shortage of community health workers (CHWs) is expected to reach 12.9 million by 2035. This shortfall raises pressing questions about how CHWs are recruited, trained, and supported as front-line care providers. Lay people become CHWs in a variety of ways; they might be chosen by a non-governmental organization or a government programme, elected by community members, or simply volunteer themselves at the right time and place. After recruitment, CHWs typically undergo training, and the scope and quality of this training can vary enormously. Often, limited funds are stretched to conduct trainings in person at facilities that may or may not be readily accessible for health workers, and refresher trainings are often cut in times of budget shortfall. While there may be no simple solution to these challenges, many now look to the use of digital technologies as a promising opportunity. Digital health interventions have come to play a growing role in healthcare in the last decade, yet the uses of technology for training, ongoing education, and supportive supervision remain understudied in lower-income settings. In this chapter, we examine a case study of digital health interventions in Nepal. We examine matters of baseline literacy and access to technology, the interweaving of technology and health system design issues, and prospects for integrating digital and face-to-face education and support. While the role of technology is easily overstated, we nonetheless argue that new digital workflows can address real implementation challenges if designed in a human-centred manner.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"184 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126240366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0010
C. Brown
This chapter considers the theory and practice of the evaluation of CHW training. It aims to provide guidance on how to conduct evaluations, focusing on evaluations seeking a quantitative measure of effectiveness. The authors highlight the usefulness of ‘thinking through’ how the training is expected to work by developing a logic model. They then show how the model can be used to help design an appropriate evaluation. In addition, potential study designs and ‘end points’ or outcomes to be measured are discussed. However, the authors emphasize, that these elements need to be considered concurrently, because the appropriateness of the study design depends, in part, on the primary outcome measure for the evaluation. The chapter concludes by describing the benefits of mixed methods research and a number of other considerations when designing, implementing, and writing up the important task of evaluating CHW training.
{"title":"Methods of Evaluation of Community Health Worker Training","authors":"C. Brown","doi":"10.1093/oso/9780198866244.003.0010","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0010","url":null,"abstract":"This chapter considers the theory and practice of the evaluation of CHW training. It aims to provide guidance on how to conduct evaluations, focusing on evaluations seeking a quantitative measure of effectiveness. The authors highlight the usefulness of ‘thinking through’ how the training is expected to work by developing a logic model. They then show how the model can be used to help design an appropriate evaluation. In addition, potential study designs and ‘end points’ or outcomes to be measured are discussed. However, the authors emphasize, that these elements need to be considered concurrently, because the appropriateness of the study design depends, in part, on the primary outcome measure for the evaluation. The chapter concludes by describing the benefits of mixed methods research and a number of other considerations when designing, implementing, and writing up the important task of evaluating CHW training.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115265776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0003
D. Palazuelos, S. Gadi
Community health workers (CHW) are often trained through a series of initial classes followed by continuing education opportunities. While this classic structure is invaluable for ensuring that the CHW has access to the right knowledge so that they can develop the right skills and attitudes to do their job, this chapter argues that this is insufficient. An equally as important and influential determinant of how the CHW will work will be the quality of the job and the quality of the health system to which they contribute. This is part of the ‘hidden curriculum’, and it is too often underappreciated when planning to train CHWs. CHWs are often seen as a cheaper solution to help meet the human resources for health crisis, but this chapter argues that if they are only given medical tasks, and if their role is medicalized to the point of removing them from how their communities function, then health systems will lose access to important opportunities to improve quality and healthcare outcomes.
{"title":"Learning How Not to Train the Community Out of the Community Health Workers","authors":"D. Palazuelos, S. Gadi","doi":"10.1093/oso/9780198866244.003.0003","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0003","url":null,"abstract":"Community health workers (CHW) are often trained through a series of initial classes followed by continuing education opportunities. While this classic structure is invaluable for ensuring that the CHW has access to the right knowledge so that they can develop the right skills and attitudes to do their job, this chapter argues that this is insufficient. An equally as important and influential determinant of how the CHW will work will be the quality of the job and the quality of the health system to which they contribute. This is part of the ‘hidden curriculum’, and it is too often underappreciated when planning to train CHWs. CHWs are often seen as a cheaper solution to help meet the human resources for health crisis, but this chapter argues that if they are only given medical tasks, and if their role is medicalized to the point of removing them from how their communities function, then health systems will lose access to important opportunities to improve quality and healthcare outcomes.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"623 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116403667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0002
R. Panjabi, L. Long, M. Bailey, Magnus Conteh
Community health workers (CHWs) often represent the first point of contact for many individuals in low-income countries accessing health services. Unfortunately, due to the low quality of care, outcomes for many people are unpredictable. Although the causes for poor quality of care are multifaceted, one obvious cause is that many CHWs are undertrained. Given the scope of the problem and the lack of resources available to solve it, governments and donor organizations are looking at digital technologies to help address problems such as access to services, health worker training, and decision-making. Access to and understanding of educational content can be improved by combining classroom education with distance learning to create a blended learning approach. Furthermore, by integrating the educational experience offered to CHWs through technology with related support services such as data collection, logistics management and AI-based decision support, governments can compensate for the quality of care gap.
{"title":"The Role of Technology in Supporting the Education of Community Health Workers and their Leaders","authors":"R. Panjabi, L. Long, M. Bailey, Magnus Conteh","doi":"10.1093/oso/9780198866244.003.0002","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0002","url":null,"abstract":"Community health workers (CHWs) often represent the first point of contact for many individuals in low-income countries accessing health services. Unfortunately, due to the low quality of care, outcomes for many people are unpredictable. Although the causes for poor quality of care are multifaceted, one obvious cause is that many CHWs are undertrained. Given the scope of the problem and the lack of resources available to solve it, governments and donor organizations are looking at digital technologies to help address problems such as access to services, health worker training, and decision-making. Access to and understanding of educational content can be improved by combining classroom education with distance learning to create a blended learning approach. Furthermore, by integrating the educational experience offered to CHWs through technology with related support services such as data collection, logistics management and AI-based decision support, governments can compensate for the quality of care gap.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128486650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0004
James O’Donovan
Training and supervision are core to the development of an effective CHW programme and have been recognized as so for many years. Their development and framing are important to understand from a historical perspective as this has ultimately helped to shape current approaches in the field. However, current CHWs face many related challenges, including determining their key benefits, whom they serve, and the mechanisms by which these benefits occur. This chapter directly addresses these issues by highlighting some of the key opportunities that could play a role in helping overcome some of these challenges, such as the role of mobile technologies. It is a starting point for developing the foundations for beginning to understand the complexities of this fragmented, contested, and important field of study and practice.
{"title":"Approaches to Community Health Worker Training and Supervision","authors":"James O’Donovan","doi":"10.1093/oso/9780198866244.003.0004","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0004","url":null,"abstract":"Training and supervision are core to the development of an effective CHW programme and have been recognized as so for many years. Their development and framing are important to understand from a historical perspective as this has ultimately helped to shape current approaches in the field. However, current CHWs face many related challenges, including determining their key benefits, whom they serve, and the mechanisms by which these benefits occur. This chapter directly addresses these issues by highlighting some of the key opportunities that could play a role in helping overcome some of these challenges, such as the role of mobile technologies. It is a starting point for developing the foundations for beginning to understand the complexities of this fragmented, contested, and important field of study and practice.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128178112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-06DOI: 10.1093/oso/9780198866244.003.0011
M. Kelley, N. Fancourt
It is increasingly recognized internationally that community health workers need to be experts in mediating between health facilities and the health needs of their particular communities, requiring interpersonal skills to balance the ethical, medical or physiological health issues, and the community dynamics. For this relational expertise to flourish, a culture of recognition, mutual respect, and support is essential between the community health workers, other health professionals, and the community. A relational pedagogy for training and supervision is outlined to address some key ethical values: mutual respect and recognition; shared decision-making and solidarity; relational agency and empowerment; fairness and inclusion; and shared advocacy. We argue that explicitly putting these values foremost in supervision, training and practice will equip community health workers with appropriate strategies to develop and sustain their unique and valued expertise.
{"title":"Recognition, Mutual Respect, and Support","authors":"M. Kelley, N. Fancourt","doi":"10.1093/oso/9780198866244.003.0011","DOIUrl":"https://doi.org/10.1093/oso/9780198866244.003.0011","url":null,"abstract":"It is increasingly recognized internationally that community health workers need to be experts in mediating between health facilities and the health needs of their particular communities, requiring interpersonal skills to balance the ethical, medical or physiological health issues, and the community dynamics. For this relational expertise to flourish, a culture of recognition, mutual respect, and support is essential between the community health workers, other health professionals, and the community. A relational pedagogy for training and supervision is outlined to address some key ethical values: mutual respect and recognition; shared decision-making and solidarity; relational agency and empowerment; fairness and inclusion; and shared advocacy. We argue that explicitly putting these values foremost in supervision, training and practice will equip community health workers with appropriate strategies to develop and sustain their unique and valued expertise.","PeriodicalId":287785,"journal":{"name":"Training for Community Health","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133574175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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