Trust of community health workers influences the acceptance of community-based maternal and child health services

Abstract

BackgroundCommunity health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings.AimTo explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves.SettingPrimary health care clinics in five rural districts in KwaZulu-Natal, South Africa.MethodsA qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing.ResultsPoor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community.ConclusionUnderstanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study

“…The unpreparedness of primary health care facilities to support NCD prevention and control has been reported previously [15,16,35]. Patients have also complained about the quality of care and unavailability of commodities and supplies [35] while CHWs are weary of their relationship with health workers at facilities [42]. These factors could also offer an explanation for the high demand for biomedical interventions from CHWs.…”

“…This is especially key in dealing with NCDs that mostly require lifestyle changes. Since trust and maintenance of confidentiality are key to CHWs' acceptance in delivering health services [38,42,43], CHWs trainings, support and supervision should cover effective ways to relate and improve their relationships with community members and the health system, which is as important as services delivery [31,38,42].…”

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…As a chronic condition, HIV requires lifelong engagement with the health system. In addition, health care workers are members of their communities and are often looked to for guidance on health and other issues [30‐32]. Health workers are a potentially powerful force not only to reduce stigma in their health facilities, but to be change agents in their homes and communities.…”

Client satisfaction and Competency of Healthcare Providers with the services of BRAC Maternity Centres – A Cross Sectional Study

“…Much of the success of any health intervention relies on positive and trusting relationships at individual, patient-provider and systemic levels. The magnitude of the role and the role of trust in health systems is often underestimated (Grant et al, 2017). Almost all the patients/ attendants were satisfied with the services received and expressed intentions to come back again and also refer to other people.…”