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

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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Dust or disease? Perceptions of influenza in rural Southern Malawi

10.1101/470856 ◽

2018 ◽

Author(s):

Mackwellings Phiri ◽

Kate Gooding ◽

Ingrid Peterson ◽

Ivan Mambule ◽

Spencer Nundwe ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

Health Centre ◽

Traditional Healers ◽

Public Understanding ◽

Low Income Countries ◽

Health Seeking ◽

Prevention And Treatment

AbstractBackgroundInfluenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities’ ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi.MethodsWe conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups.ResultsRespondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza.ConclusionOur findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers. Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents’ interest in further information and support informed health seeking and engagement with future influenza interventions.

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Supervising community health workers in low-income countries – a review of impact and implementation issues

Global Health Action ◽

10.3402/gha.v7.24085 ◽

2014 ◽

Vol 7 (1) ◽

pp. 24085 ◽

Cited By ~ 83

Author(s):

Zelee Hill ◽

Mari Dumbaugh ◽

Lorna Benton ◽

Karin Källander ◽

Daniel Strachan ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

Low Income Countries

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The Role of Technology in Supporting the Education of Community Health Workers and their Leaders

10.1093/oso/9780198866244.003.0002 ◽

2021 ◽

pp. 11-24

Author(s):

Raj Panjabi ◽

Lesley-Anne Long ◽

Michael Bailey ◽

Magnus Conteh

Keyword(s):

Quality Of Care ◽

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

Poor Quality ◽

Low Income Countries ◽

Worker Training ◽

Care Outcomes

Community health workers (CHWs) often represent the first point of contact for many individuals in low-income countries accessing health services. Unfortunately, due to the low quality of care, outcomes for many people are unpredictable. Although the causes for poor quality of care are multifaceted, one obvious cause is that many CHWs are undertrained. Given the scope of the problem and the lack of resources available to solve it, governments and donor organizations are looking at digital technologies to help address problems such as access to services, health worker training, and decision-making. Access to and understanding of educational content can be improved by combining classroom education with distance learning to create a blended learning approach. Furthermore, by integrating the educational experience offered to CHWs through technology with related support services such as data collection, logistics management and AI-based decision support, governments can compensate for the quality of care gap.

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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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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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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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Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

Gates Open Research ◽

10.12688/gatesopenres.13071.1 ◽

2019 ◽

Vol 3 ◽

pp. 1652 ◽

Cited By ~ 1

Author(s):

Muluneh Yigzaw Mossie ◽

Anne Pfitzer ◽

Yousra Yusuf ◽

China Wondimu ◽

Eva Bazant ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Community Health ◽

Low Income ◽

Health Workers ◽

Continuum Of Care ◽

Low Income Countries ◽

Health Extension Workers ◽

Pregnancy Risk ◽

The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

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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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