Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol

Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno

doi:10.1136/bmjopen-2014-006752

Cited by 25 publications

(28 citation statements)

References 51 publications

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“…Coupled with limited geographical access to existing facilities or inadequately stocked facilities, these challenges have impacted negatively on health indicators in these countries. Community-based health workers have been crucial in bridging these gaps in provision of equitable healthcare and in expanding essential health services to the community through a range of preventive, promotive, and curative services (2–4). …”

Section: Introductionmentioning

confidence: 99%

“…However, the findings have been heterogeneous and influenced by many factors (4, 8), including socio-demographic, political, economic, and workplace environments. Workload, attrition rates, gender roles, level of education, political commitment and employment status, job aides, and physical workplace environment have a significant influence on such workers’ performance (3–6, 9–15).…”

Section: Introductionmentioning

confidence: 99%

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Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Kuule¹,

Dobson²,

Woldeyohannes

et al. 2017

Front. Public Health

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IntroductionCommunity health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. However, their performance has been heterogeneous and at times context-specific, and influenced by multiple factors. We describe the socio-demographic and workplace characteristics affecting CHVs’ performance in a public health program in rural western Uganda.MethodsThis was a cross-sectional study based on routine program data of CHVs serving the catchment of Bwindi Community Hospital, Kanungu District, South Western Uganda, in 2014 and 2015. Information was collected on individual socio-demographic and workplace characteristics of the CHVs. To assess their work output, we defined study-specific targets in terms of attendance at monthly CHVs’ meetings with community health nurses, households followed-up and reported, children screened for malnutrition, immunization coverage, and health facility deliveries. Frequencies and proportions are reported for characteristics and outputs and odds ratios for study-specific factors associated with overall performance.ResultsOf the 508 CHVs, 65% were women, 48% were aged 35 years and below, and 37% took care of more than the recommended 20–30 households. Seventy-eight percent of the CHVs had ≥80% of pregnant women under their care delivering in health units, 71% had ≥95% of the children on schedule for routine immunization, while 27% screened ≥75% of the children under 5 years for malnutrition. More refresher trainings was associated with better overall performance [adjusted odds ratio (aOR): 12.2, 95% confidence interval (CI): 1.6–93.6, P = 0.02] while overseeing more than the recommended 20–30 households reduced overall performance (aOR: 0.6, 95% CI: 0.4–0.9, P = 0.02).ConclusionBeing in-charge of more than the recommended households was associated with reduced performance of CHVs, while more refresher trainings were associated with improved performance. If the CHVs are to remain a strategic pillar in universal health coverage, it is imperative to address those factors known to impact on their performance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Kuule¹,

Dobson²,

Woldeyohannes

et al. 2017

Front. Public Health

View full text Add to dashboard Cite

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“…3 It is well established that CHWs can make a positive impact on the health and wellbeing of the communities they serve 6 and an extensive body of literature supports their effectiveness in the delivery of primary healthcare programmes. [7][8][9] Specifically, there is a large body of work on CHWs for maternal and child health 10 11 and HIV and AIDS programming. 12 13 Recent studies have also drawn attention to the challenges in implementing CHW programmes including ensuring regular and supportive supervision (F Vallières, E McAuliffe, P Hyland, et al Measuring the supervision of community health workers: developing and validating the perceived supervision scale.…”

Section: Introduction Community Health Workersmentioning

confidence: 99%

Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme

et al. 2016

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IntroductionUnderstanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies.Methods and analysisThe suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand ‘what works, for whom and under what conditions’ for improving CHW performance within humanitarian contexts.Ethics and disseminationTrinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination activities will involve a mixture of research feedback, policy briefs, guidelines and recommendations, as well as open source academic articles.

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“…Using concepts from abstract theory which are selected purposively for the research synthesis or evaluation by the research team but which have not been referenced in the program literature. For example, Vareilles, Pommier, Kane, Pictet, and Marchal(2015) cite "selfdetermination theory" which was used as a framework for IRPT development to understand the performance of community health volunteers. Extracting tacit theories about what is working and why from interventions on similar topics, reported in the literature (Lhussier, Carr, & Forster, 2016;Pearson et al, 2015).…”

Section: Strategies For Building Irptsmentioning

confidence: 99%

Building Realist Program Theory for Large Complex and Messy Interventions

Shearn

Allmark

Piercy

et al. 2017

International Journal of Qualitative Methods

139

192

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Program theory, that is, the specific idea about how a program causes the intended or observed outcomes, should be the central aspect of any realist evaluation or synthesis. The methods used for explicating or building initial rough program theories (IRPTs) in realist research are varied and arguably often underreported. In addition, preexisting psychological and sociological theories, at a higher level of abstraction, could be used to a greater extent to inform their development. This article illustrates a method for building IRPTs for use in realist research evaluation and synthesis. This illustration involves showing how the IRPTs were developed in a realist evaluation concerning sexual health services for young people. In this evaluation, a broad framework of abstract theories was constructed early in the process to support IRPT building and frame more specific program theories as they were developed. These abstract theories were selected to support theorizing at macro-, meso-, and microlevels of social structure. This article discusses the benefits of using this method to build initial theories for particular types of interventions that are large, complex, and messy. It also addresses challenges relating to the selection of suitable theories.Keywords realist, program theory, sexual health, young people, middle-range theory, adolescents, organizational change, conceptual framework What Is Already Known?Methods for developing initial theories in realist research are varied and underreported. Additionally, existing abstract theories are often used to substantiate rather than inform program theory development. What This Paper Adds?This paper provides an account of program theory development in a realist evaluation of positive comprehensive youth sexual health services. It offers a rationale for early development of a framework of abstract theories to improve coherence, quality, and transparency in realist research and a set of criteria for selecting abstract theories.

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Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol

Cited by 25 publications

References 51 publications

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme

Building Realist Program Theory for Large Complex and Messy Interventions

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