The impact of community health workers on the self-determination, self-sufficiency, and decision-making ability of low-income women and mothers of young children

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1–6) and dosing, titration, and emergencies (TEST-2, months 7–12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants’ (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3–17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

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Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽

10.3390/nu13020367 ◽

2021 ◽

Vol 13 (2) ◽

pp. 367

Author(s):

Pilar Charle-Cuéllar ◽

Noemí López-Ejeda ◽

Mamadou Traore ◽

Adama Balla Coulibaly ◽

Aly Landouré ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Community Intervention ◽

Health Workers ◽

Acute Malnutrition ◽

Control Group ◽

Supportive Supervision ◽

Supervision Group ◽

Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

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Ongoing training of community health workers in low-income andmiddle-income countries: a systematic scoping review of the literature

BMJ Open ◽

10.1136/bmjopen-2017-021467 ◽

2018 ◽

Vol 8 (4) ◽

pp. e021467 ◽

Cited By ~ 23

Author(s):

James O’Donovan ◽

Charles O’Donovan ◽

Isla Kuhn ◽

Sonia Ehrlich Sachs ◽

Niall Winters

Keyword(s):

Community Health ◽

Community Health Workers ◽

Scoping Review ◽

Low Income ◽

Health Workers ◽

Review Of The Literature ◽

Ongoing Training

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Strategies Used By Community Health Workers to Influence Adoption of Maternal Nutrition Behaviors in Rural Bangladesh: A Focused Ethnographic Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_076 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1359-1359

Author(s):

Gargi Wable Grandner ◽

Katherine Dickin ◽

Purnima Menon ◽

Tiffany Yeh ◽

John Hoddinott

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Maternal Nutrition ◽

Health Workers ◽

Ethnographic Study ◽

Low Income Countries ◽

Cultural Congruence ◽

Healthy Tree ◽

Diet Diversity

Abstract Objectives Efforts to integrate nutrition into antenatal health promotion in low income countries have led to increased involvement of community health workers (CHWs) in counseling on maternal nutrition. Little is known about how CHWs “package” messages in resource-poor communities to increase adoption of recommended maternal nutrition behaviors. We developed focused ethnographic techniques to explore this. Methods We interviewed 35 randomly selected CHWs providing monthly counseling to pregnant women and their families in 7 ‘Alive & Thrive’ intervention sites in Bangladesh. Two sorting exercises explored CHW strategies for promoting and perceptions of adoption of messages on micronutrient supplements, maternal dietary adequacy, and rest during pregnancy. In-depth probing on messages identified as “difficult” to deliver or adopt revealed how CHWs addressed barriers. Analysis of quantitative sorting data complemented thematic coding of qualitative textual data using grounded theory. Results CHW communication strategies involved 3 themes: feasibility (attitudes, norms, agency, poverty), audience (influence, motivators, support), and linguistic choice (emotional appeals, metaphors, logic, sellable but inaccurate arguments). CHWs viewed micronutrient messages as least difficult to adopt, requiring minimal “packaging”. Dietary messages were moderately difficult to adopt, prompting CHWs to leverage cultural congruence to target family members with different strategies. For example, messaging on diet diversity targeted husbands—the primary food-buyers—with logical arguments highlighting costs of inaction. When mothers-in-law held beliefs restricting gestational food intake, CHWs used metaphors (‘healthy tree, healthy fruit’) or faith-based appeals. Some CHWs used inaccurate messages (‘mother rests, baby rests’) to promote rest during pregnancy because it was seen as the least feasible behavior to adopt. Conclusions Where behavior change is viewed as feasible, CHWs use culturally resonant strategies to enhance adoption of maternal nutrition behaviors. Cultural congruence, or shared beliefs, language and cultural identity, is key to CHW effectiveness, but unhelpful for contextually infeasible behaviors. BCC programs co-designed with CHWs could improve messaging and effectiveness. Funding Sources Cornell AWARE Travel Grant.

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Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines

BMC Health Services Research ◽

10.1186/s12913-020-05699-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Eunice Mallari ◽

Gideon Lasco ◽

Don Jervis Sayman ◽

Arianna Maever L. Amit ◽

Dina Balabanova ◽

...

Keyword(s):

Qualitative Study ◽

Community Health ◽

Community Health Workers ◽

Financial Incentives ◽

Lived Experiences ◽

Health Workers ◽

The Philippines ◽

Community Members ◽

Cross Sectional ◽

The Impact

Abstract Background Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. Methods This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Results Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. Conclusions These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.

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Assessing community health workers’ conditions for delivering care to patients in low-income communities

Applied Ergonomics ◽

10.1016/j.apergo.2019.102944 ◽

2020 ◽

Vol 82 ◽

pp. 102944 ◽

Cited By ~ 1

Author(s):

Alessandro Jatobá ◽

Hugo Cesar Bellas ◽

Bárbara Bulhões ◽

Isabella Koster ◽

Rodrigo Arcuri ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers

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Community health workers: to train or to restrain? A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau

Human Resources for Health ◽

10.1186/1478-4491-12-8 ◽

2014 ◽

Vol 12 (1) ◽

Cited By ~ 17

Author(s):

Sérgio C Lopes ◽

António J Cabral ◽

Bruno de Sousa

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Longitudinal Survey ◽

Guinea Bissau ◽

Training Community ◽

The Impact

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Screening and Referral for Postpartum Depression among Low-Income Women: A Qualitative Perspective from Community Health Workers

Depression Research and Treatment ◽

10.1155/2011/320605 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Rhonda C. Boyd ◽

Marjie Mogul ◽

Deena Newman ◽

James C. Coyne

Keyword(s):

Mental Health ◽

Postpartum Depression ◽

Focus Groups ◽

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

Academic Community ◽

Barriers And Facilitators ◽

Postpartum Women

Postpartum depression is a serious and common psychiatric illness. Mothers living in poverty are more likely to be depressed and have greater barriers to accessing treatment than the general population. Mental health utilization is particularly limited for women with postpartum depression and low-income, minority women. As part of an academic-community partnership, focus groups were utilized to examine staff practices, barriers, and facilitators in mental health referrals for women with depression within a community nonprofit agency serving low-income pregnant and postpartum women. The focus groups were analyzed through content analyses and NVIVO-8. Three focus groups with 16 community health workers were conducted. Six themes were identified: (1) screening and referral, (2) facilitators to referral, (3) barriers to referral, (4) culture and language, (5) life events, and (6) support. The study identified several barriers and facilitators for referring postpartum women with depression to mental health services.

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How Can We Improve the Consumption of a Nutritionally-Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the ‘Balanced Plate’ Intervention

10.20944/preprints202007.0197.v1 ◽

2020 ◽

Author(s):

Ashraful Alam ◽

Morseda Chowdhury ◽

Michael John Dibley ◽

Camille Raynes-Greenow

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Controlled Trial ◽

Maternal Diet ◽

Intervention Strategy ◽

Rural Bangladesh ◽

Portion Sizes ◽

The Impact ◽

Practical Demonstration

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observation of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Programs to promote a nutritious maternal diet should focus on encouraging the use of healthy foods through practical demonstration of portion sizes and engagement of the women and family instead of replicating the traditional information-based counselling.

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