Background: There is growing global recognition that community health workers (CHWs) play a key role in facilitating social connectedness. Through direct interactions and relationship building, CHWs link people to key services such as healthcare and social support. Several models aim to understand how CHWs facilitate these interactions, but the theory of change is not yet fully understood. In Neno District, Malawi, CHWs recently transitioned from a disease-focused model to what we call the “household model.” Under the household model, each CHW is assigned to several households to provide screening and linkage to care, as well as psychosocial and chronic disease support. We theorise that this public health approach facilitates social connectedness in the households and rural communities served by CHWs. We aim to understand drivers of influence on social connections from the CHW-, healthcare worker-, and patient perspectives. Methods: This was a cross-sectional qualitative study utilising focus group discussions (FGDs) and in-depth semi-structured interviews with purposively sampled community stakeholders, CHWs, health service providers, and patients (total N=180) from October 2018 through March 2020. Results: Participants reported improved social interactions and connectedness and increased access to health care in their communities following the transition to the household model. This was driven by factors including reduced stigma and discrimination, empowerment of households and community members, and fostering both social cohesiveness and individual agency in accessing health services. The main themes that emanated from this study are; expansion of care by CHWs, trust in CHW’s provision of care, and equal treatment of community members by CHWs. Conclusion: Our study demonstrates that through the polyvalent household model, CHWs foster high levels of social connectedness in the communities, evidenced by a reported reduction in stigma and discrimination and an increase in individual agency in accessing health services.
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