Exploring the perceptions and experiences of community health workers using role identity theory

Abstract

BackgroundCommunity health workers (CHWs) are an integral resource in many health systems, particularly in resource-poor settings. Their identities – ‘who’ they are – play an important role in their hiring, training, and retention. We explore the perceptions, experiences, and identities of CHWs as they adopt a CHW role in rural South Africa, using ‘role identity theory’.DesignFrom April to December 2010, we conducted 18 semi-structured interviews with CHWs volunteering in non-governmental home-based care (HBC) organisations in one rural sub-district in South Africa. The role identity theory framework was used to understand the work of CHWs within their communities, addressing themes, such as entry into, and nature of, caring roles, organisational support, state resourcing, and community acceptability. A thematic content analysis was used to analyse the collected data.ResultsThe study found that CHWs usually begin their ‘caring work’ before they formally join HBC organisations, by caring for children, neighbours, mothers, fathers, friends, and the community in some way. CHWs felt that becoming a health worker provided an elevated status within the community, but that it often led community members to believe they were able to control resources. The key role identities assumed by CHWs, as they sought to meet patients’ and their own needs, were a complex mix of community ‘insider’, ‘outsider’, and ‘broker’. Each of these role identities served as a unique way to position, from the CHW's perspective, themselves and the community, given the diversity of needs and expectations.ConclusionsThese role identities reveal the tensions CHWs face as ‘insider’ members of the community and yet at times being treated as ‘outsiders’, who might be regarded with suspicion, and at the same time, appreciated for the resources that they might possess. Understanding role identities, and how best to support them, may contribute to strategies of retention and sustainability of CHW programmes, as their formalisation in different contexts continues to grow.

Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry

“…The role of the CHWs within the outreach teams is mainly to strengthen the interface between the households and health facility services [12,13]. The CHWs provide various services, which include linking communities to the healthcare system, preventative care and keeping track with disease outbreak [21], as well as offering community-based healthcare and social support to complement rather than substitute the more specialised services of the healthcare system [13]. In a study conducted in rural South Africa, it was reported that the CHWs negotiated and established a personalised client-centred package of care, and that they continually assessed and adapted the package of services for each client and household as circumstances evolved [12].…”

“…CHWs repeatedly visits clients, personally attend to them, collect their medicines and advocate for them with either their families or health providers in cases of access barriers [13]. The WHO indicate that CHWs are essential in PHC as they have been shown to assist in improving health outcomes in communities [12,21]. …”

Dental School Faculty Attitudes Toward Dental Therapy: A Four‐Year Follow‐Up

“…While the response rate was lower in 2014 (30%) than in 2010 (50%), the demographic characteristics of the respondents were similar in the two surveys (Table lution in Minnesota. 5 This theory helped explain why the faculty members could remain true to their teaching role while beginning the process of understanding the new profession. Conceptually, role identity is the process by which individuals give meaning to themselves in relation to a specific role; it explains how roles develop in societies and how people represent who they are in various contexts, including their working environment.…”

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

“…First, CHWs and PLH in the FGD were all women. The gender composition of CHWs is representative of CHWs’ gender in general (Kane et al, 2016; Mlotshwa et al, 2015). The gender composition of PLH does not reflect the gender composition of the HIV epidemic and highlights difficulties in engaging and retaining South African men in care (Geng et al, 2010).…”

“…We examine perceptions towards mHealth, biometric identification and essential features in future mHealth systems. We build on prior qualitative work in South Africa that examined perceptions of Mxit (a social media network) users towards the proposed National Health Insurance plan (Weimann & Stuttaford, 2014), perceptions of young people towards youth-oriented health services (Schriver, Meagley, Norris, Geary & Stein, 2014), CHW roles (Druetz, Kadio, Haddad, Kouanda & Ridde, 2015; Kane et al, 2016; Mlotshwa, Harris, Schneider & Moshabela, 2015), perceptions of program managers and researchers towards mHealth capabilities and CHWs (Leon & Schneider, 2012), and perceptions of bank employees (Pooe & Labuschagne, 2011) and the general population (Riley, Buckner, Johnson & Benyon, 2009) towards biometric technology used for identification.…”