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

(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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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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Risk Behavior for Falls in the Elderly: Experiences of Community Health Workers

Aquichan ◽

10.5294/aqui.2020.20.2.3 ◽

2020 ◽

Vol 20 (2) ◽

pp. 1-11

Author(s):

Renata Francielle Melo dos Reis Fonseca ◽

Silvia Matumoto ◽

Joab Jefferson da Silva Xavier ◽

Jossiane Wilke Faller

Keyword(s):

Community Health ◽

Risk Behaviors ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

Elderly Person ◽

The Elderly ◽

Extrinsic Factors ◽

Related Factors ◽

Study Results

Objective: To identify the risk behaviors of the elderly at home, described by community health workers, and related factors. Materials and methods: Qualitative research, in the dialectical perspective, carried out through a focus group with community health workers from a family health strategy unit in a municipality of the State of São Paulo, Brazil. Thematic content analysis was used for the study. Results: The revealed risk behaviors are related to extrinsic factors (architecture, furniture, and equipment), socioeconomic factors (low income, level of education, deficit of social and a family support), and psychological factors (feeling of vulnerability, dependence and not self-acknowledging in a dangerous condition). Conclusions: Falls are the result of a complex interaction between the factors and, the behaviors studied so that adequate identification of these can subsidize individual and collective intervention actions, as well as care management and planning processes aimed at the health of the elderly person.

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Community health workers at the dawn of a new era

Health Research Policy and Systems ◽

10.1186/s12961-021-00761-7 ◽

2021 ◽

Vol 19 (S3) ◽

Author(s):

Joseph M. Zulu ◽

Henry B. Perry

Keyword(s):

Community Health ◽

Population Health ◽

Community Health Workers ◽

Low Income ◽

Large Scale ◽

Health Workers ◽

The United States ◽

Noncommunicable Diseases ◽

Full Potential ◽

New Era

Abstract Background There is now rapidly growing global awareness of the potential of large-scale community health worker (CHW) programmes not only for improving population health but, even more importantly, for accelerating the achievement of universal health coverage and eliminating readily preventable child and maternal deaths. However, these programmes face many challenges that must be overcome in order for them to reach their full potential. Findings This editorial introduces a series of 11 articles that provide an overview highlighting a broad range of issues facing large-scale CHW programmes. The series addresses many of them: planning, coordination and partnerships; governance, financing, roles and tasks, training, supervision, incentives and remuneration; relationships with the health system and communities; and programme performance and its assessment. Above all, CHW programmes need stronger political and financial support, and this can occur only if the potential of these programmes is more broadly recognized. The authors of the papers in this series believe that these challenges can and will be overcome—but not overnight. For this reason, the series bears the title “Community Health Workers at the Dawn of a New Era”. The scientific evidence regarding the ability of CHWs to improve population health is incontrovertible, and the favourable experience with these programmes at scale when they are properly designed, implemented, and supported is compelling. CHW programmes were once seen as a second-class solution to a temporary problem, meaning that once the burden of disease from maternal and child conditions and from communicable diseases in low-income countries had been appropriately reduced, there would be no further need for CHWs. That perspective no longer holds. CHW programmes are now seen as an essential component of a high-performing healthcare system even in developed countries. Their use is growing rapidly in the United States, for instance. And CHWs are also now recognized as having a critically important role in the control of noncommunicable diseases as well as in the response to pandemics of today and tomorrow in all low-, middle-, and high-income countries throughout the world. Conclusion The promise of CHW programmes is too great not to provide them with the support they need to achieve their full potential. This series helps to point the way for how this support can be provided.

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Evaluation of human papillomavirus self-collection offered by community health workers at home visits among under-screened women in Brazil

Journal of Medical Screening ◽

10.1177/0969141320941056 ◽

2020 ◽

pp. 096914132094105

Author(s):

Naitielle de Paula Pantano ◽

José H Fregnani ◽

Júlio CP Resende ◽

Luiz C Zeferino ◽

Bruno de Oliveira Fonseca ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Community Health ◽

Community Health Workers ◽

Low Income ◽

Pap Smear ◽

Health Workers ◽

Major Public Health Problem ◽

Adult Women

Objective To explore the acceptability of high-risk human papillomavirus self-testing, involving community health workers, for never/under-screened Brazilian women. Cervical cancer is the most common cause of cancer-related death among adult women in a large number of low-income and lower-middle-income countries, where it remains a major public health problem. High-risk human papillomavirus persistence is required for the development of cervical neoplasia. Methods The target population was all women aged 30+ from the list of families available in healthcare centre data, who had never been screened or were not screened in the previous 3 years (under-screened women), and who were living in the 17 cities included in this study. Results Of the 377 women included, 16.9% ( n = 64) had never had a pap smear. Of all samples included in the study, 97.1% ( n = 366) were considered adequate for evaluation, as 2.9% ( n = 11) were considered invalid for all high-risk human papillomavirus types. Analysing these 366 samples, 9.6% ( n = 35) of the women were infected by at least one high-risk human papillomavirus type and 90.4% ( n = 331) had no infection with any high-risk type of the virus. Conclusions Vaginal self-sampling is an adequate strategy to improve the effectiveness of the cervical cancer program by increasing screening in a high-risk group.

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Community health workers’ attitudes, practices and perceptions towards the COVID-19 pandemic in brazilian low-income communities

Work ◽

10.3233/wor-205000 ◽

2021 ◽

pp. 1-9

Author(s):

Nilson do Rosário Costa ◽

Hugo Bellas ◽

Paulo Roberto Fagundes da Silva ◽

Paulo Victor Rodrigues de Carvalho ◽

Deborah Uhr ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Online Survey ◽

Health Workers ◽

Sampling Error ◽

Access To Health Services ◽

The Face ◽

Modes Of Interaction ◽

Poor Communities

BACKGROUND: Community Health Workers (CHW) are a category of social workers described in many countries’ health systems as responsible for engaging people in their residences and communities, and other non-clinical spaces to enable access to health services, especially in low-income areas. These professionals have been exposed to numerous new risks during the COVID-19 pandemic. OBJECTIVE: This study describes how the COVID-19 pandemic is perceived by CHWs who work in poor communities or slums in Brazil. METHODS: We conducted an online survey with a random sample of 775 CHWs operating in 368 municipalities of the 26 Brazilian states. At a confidence level of 95% , results of the survey were subject to a maximum sampling error of 4% . RESULTS: Our data indicate that the negationist agenda increases the challenges to the performance of CHWs within low-income communities, preventing the consensus on the necessity of social distancing, business closures and other measures to face the COVID-19 pandemic. CONCLUSION: The pandemic imposes unexpected challenges on the usual modes of interaction of public health officers with poor communities. This study provides evidence that these challenges have been ignored or minimized in Brazilian policy prescriptions for primary care in the face of the COVID-19 pandemic.

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The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study

Journal of Community Health ◽

10.1007/s10900-018-0491-3 ◽

2018 ◽

Vol 43 (5) ◽

pp. 842-847 ◽

Cited By ~ 4

Author(s):

Julie Silverman ◽

James Krieger ◽

George Sayre ◽

Karin Nelson

Keyword(s):

Qualitative Study ◽

Community Health ◽

Community Health Workers ◽

Low Income ◽

Diabetes Management ◽

Health Workers

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Advancing Community Health Workers Through Higher Education: Lessons Learned From a Basic Certificate Program Implementation

Pedagogy in Health Promotion ◽

10.1177/2373379916671957 ◽

2016 ◽

Vol 3 (4) ◽

pp. 228-233

Author(s):

Marlon Haywood ◽

Andy Garman ◽

Tricia Johnson ◽

Beth-Anne M. Christopher ◽

Roy Walker

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Program Implementation ◽

Health Workers ◽

Clinical Care ◽

Lessons Learned ◽

Malcolm X ◽

Certificate Program ◽

Affordable Healthcare Act

The Affordable Healthcare Act has, among other changes, created greater incentives to reduce health disparities in low-income communities across the country, which heightened the importance and expectations of community health workers (CHWs) as part of the clinical care team. These heightened expectations have begun to transition what has historically been a paraprofessional role into one that involves more clearly defined competencies and development needs. In an effort to meet these needs in the city of Chicago, a CHW basic certificate program was developed and launched at Malcolm X college (one of the seven city Colleges of Chicago), in collaboration with several community partners. This article presents the experience of this program, the challenges faced in its implementation, and lessons from this experience that may be relevant to others involved in the professional preparation of CHWs.

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