Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural South African home visiting program

Abstract

Background Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa. Methods We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed. Results We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice. Conclusions These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients’ voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate.

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

“…At the interpersonal level , CHWs can develop peer relationships with their clients through frequent home visits, building up trust over time. For example, in South Africa, CHW–client peer relationships were developed within the home-visit setting and were strengthened when CHWs provided clients with even further care and support [ 22 ]. Village health volunteers (VHVs) in Thailand were able to use their peer-status relationship with clients to provide tailored support in ways that doctors and public health officials guided by medical treatment protocols could not.…”

Participant Perspectives on Community Health Workers' Critical Role in Their Experience of the Pathways Program to Address Complex Needs

“…Redding et al, 2015). Understanding the experiences of participants engaged in Pathways is essential to recognizing the full extent of the impact this model can have on people's lives and supporting ongoing engagement with communities (Laurenzi et al, 2021). The overwhelmingly positive findings from our study illustrate the key impacts Pathways had on participants and how relationships with a CHW not only facilitate connections to needed health and social services agencies but also enable participants to independently address their needs.…”

“…Pathways for care coordination, which positions CHWs as central to achieving coordination, has previously been shown to have positive medical and financial outcomes. However, evaluations of this model in the United States have focused on narrowly defined populations (eg, pregnant populations), and few studies have incorporated participant perspectives into their evaluations (Arthur & Redding, 2019;Chiyaka et al, 2019;Community Commons, n.d.;Lucas & Detty, 2019;McCarthy & Tabbush, 2020;S. Redding et al, 2015).…”

Exploration of service centres for older persons in the Eastern Cape province, South Africa

“…In view of the numbers of the current generation of older persons in the province and the anticipated increase in the number of older persons when the NDP goal of increasing the average life expectancy to 70 years is achieved, it is necessary to incorporate the screening of older persons into the training of CHWs. The findings ofLaurenzi et al (2021) highlight the critical roles that CHWs could assume in providing both instructive and supportive care to clients and their informal caregivers whilst working under the supervision of healthcare professionals, including physiotherapists. However, based on the reported positive health behaviours of the members of the centres, their self-perception and engagement in physical and social activities, the philosophy of the training of the CHWs should shift from the deficit-approach of care to building on the strengths of older persons, using the principles of health promotion interventions in the care of older persons in their communities.…”

“…(Austin-Evelyn et al 2017;Laurenzi et al 2021). In view of the numbers of the current generation of older persons in the province and the anticipated increase in the number of older persons when the NDP goal of increasing the average life expectancy to 70 years is achieved, it is necessary to incorporate the screening of older persons into the training of CHWs.…”