Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa

Katzen, Linnea Stansert; Skeen, Sarah; Dippenaar, Elaine; Laurenzi, Christina; Notholi, Vuyolwethu; Roux, Karl le; Rotheram, Mary Jane; Roux, Ingrid Le; Mbewu, Nokwanele; Tomlinson, Mark

doi:10.1002/nur.22220

Cited by 16 publications

(15 citation statements)

References 39 publications

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“…Community representation among healthcare workers has also been reported to build trust among communities and healthcare actors ( 65 , 66 ). However, these team members face unique pressures from overlapping social roles which intertwine their personal and professional lives and may result in greater levels of stress, emotional exhaustion, and burnout ( 67 , 68 ), particularly during health emergencies that disproportionately impact their communities, such as the COVID-19 pandemic. Future studies of the role of organizational relationships in implementation should consider the interaction between these relationships and “characteristics of individuals” involved in implementation ( 4 ), particularly the needs, capability, and motivation of individuals with dual roles in the implementing organization and the community of focus.…”

Section: Discussionmentioning

confidence: 99%

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

Moore,

Callaghan-Koru,

Vincenzo

et al. 2024

Front. Health Serv.

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BackgroundWhile relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions.MethodsThis study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17).ResultsAll participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators.ConclusionsAchieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.

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Section: Discussionmentioning

confidence: 99%

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

Moore,

Callaghan-Koru,

Vincenzo

et al. 2024

Front. Health Serv.

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“…These obstacles have been consistently highlighted across various studies, highlighting the universal challenges faced by HCWs in reaching and providing care to patients residing in remote or geographically inaccessible areas. For instance, research conducted in diverse settings has reiterated the impact of geographical barriers, emphasizing the difficulties faced by HCWs in delivering timely and consistent home-based care to patients in remote or rural regions [ 24 – 26 ]. Moreover, adverse weather conditions exacerbate these challenges, disrupt healthcare access, and necessitate implementation of tailored strategies.…”

Section: Discussionmentioning

confidence: 99%

Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi

Maphosa,

Denoeud-Ndam,

Kapanda

et al. 2024

BMC Health Serv Res

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Background Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support. Methods This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants’ responses. Results While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services. Conclusions These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD.

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“…Importantly, the process of task-shifting in itself may be complex, with important roles for health literacy in self-management models,(35) and the community’ social fabric in the feasibility of training lay community workers. (36) Thirdly, how can digital innovation be used equitably to promote access, uptake and/ or adherence of technology driven rehabilitation models, and, how does this affect the competencies required of those overseeing such rehabilitation services? The implications thereof, for example, may be that a single physiotherapist oversees a cadre of community health workers for coordinated physiotherapy and exercise training using a digital telehealth platform rather than solely providing face to face clinical services.…”

Section: Discussionmentioning

confidence: 99%

Towards a framework for the scale-up of rehabilitation for patients with non-communicable disease in low-resource settings

Heine

Derman

Hanekom

2022

Preprint

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Objective To explore and synthesize critical factors for the scale-up of comprehensive rehabilitation care for people with non-communicable disease in low-resourced settings. Methods A core set of 81 articles were selected from two published scoping reviews. Using the principles of thematic analysis, the core set was analysed for factors that may directly or indirectly affect the feasibility or scale-up of rehabilitation. Categories and themes were formulated via an iterative team approach using the core set (n=81). Subsequently, we triangulated the thematic analysis against our findings from a feasibility study conducted in a low-resourced, urban, setting in South Africa. Next, a validation article set (n=63) was identified by updating the searches for the respective published reviews, and a purposeful sample of articles drawn from the validation set (n=13; 20%) was used to validate the factors identified in the primary analysis based on the principles of data saturation. Findings A total of 40 different themes (i.e., critical factors) were derived from 169 categories. Subsequently the identified factors could be packaged into nine system elements principal for the scale-up of rehabilitation for people with NCDs in terms of increasing population coverage, increasing comprehensiveness, and integration within existing health structures. Conclusion A multitude of factors which affect the feasibility and scale-up of rehabilitation for NCDs in low resource settings were identified. These factors are multi-dimensional and multi-directional. Researchers and policy makers should consider these factors and their interconnectedness when planning to address the rehabilitation needs through implementation and scale-up initiatives

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Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa

Cited by 16 publications

References 39 publications

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi

Towards a framework for the scale-up of rehabilitation for patients with non-communicable disease in low-resource settings

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