Capacity Building and Training Needs for Community Health Workers Working in Health Care Organizations

Abstract Background Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective To document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System. Design We used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results Sample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.

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Book Review: Community health workers in action: The efforts of “Promotores de Salud” in bringing health care to marginalized communities by Melvin Delgardo

Journal of Social Work ◽

10.1177/14680173211017677 ◽

2021 ◽

pp. 146801732110176

Author(s):

Cynthia H. Nover

Keyword(s):

Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Marginalized Communities

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Community Health Workers: An Integral Part of an Integrated Health Care Team

North Carolina Medical Journal ◽

10.18043/ncm.77.2.129 ◽

2016 ◽

Vol 77 (2) ◽

pp. 129-130 ◽

Cited By ~ 2

Author(s):

S. Nelson ◽

E. B. Money ◽

R. Petersen

Keyword(s):

Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Health Care Team ◽

Integrated Health Care ◽

Care Team ◽

Integrated Health

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Knowledge and attitudes of tuberculosis management in San Juan de Lurigancho district of Lima, Peru

The Journal of Infection in Developing Countries ◽

10.3855/jidc.335 ◽

2009 ◽

Vol 3 (10) ◽

pp. 783-788 ◽

Cited By ~ 18

Author(s):

Elizabeth M. Kiefer ◽

Theresa Shao ◽

Olveen Carrasquillo ◽

Pamela Nabeta ◽

Carlos Seas

Keyword(s):

Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Care Providers ◽

Health Workers ◽

Knowledge Score ◽

San Juan ◽

Care Providers ◽

Knowledge Gaps ◽

Knowledge And Attitudes

Background: Expansion of the health care workforce in Peru to combat tuberculosis (TB) includes both professional health care providers (HCPs) such as doctors and nurses, and non-professional HCPs such as community health workers (CHWs). We describe the knowledge and attitudes of these HCPs, and identify modifiable barriers to appropriate anti-tuberculosis treatment. Methodology: We surveyed HCPs practicing in 30 clinical settings (hospitals, community health centers, and health posts) in the San Juan de Lurigancho district of Eastern Lima, Peru. Multiple-choice questions were used to assess knowledge of TB. A five-item Likert scale was created to assess attitudes toward the community, patients, and clinics. Linear regression was used to identify predictors of mean knowledge score, and analysis of variance was used to test differences in HCP score. Results: Of the 73 HCPs surveyed, 15% were professionals (doctors or nurses). The remaining 85% were health technicians, community health workers (CHWs) or students. The mean knowledge score was 10.0 ± 1.9 (maximum 14) with professional HCPs scoring higher than other HCPs (11.7 ± 1.1 vs. 9.7 ± 1.9), p < .01). Knowledge gaps included identification of patients at high risk for TB, assessment of treatment outcomes, and consequences of treatment failure. The most commonly cited modifiable barriers were structural, including laboratory facilities and staffing of TB clinics, with 52.1% and 62.5% of HCPs, respectively, citing these as problematic. Conclusions: Efforts to improve knowledge of TB HCPs in Peru should focus on the specific gaps we have identified. Further research is needed to evaluate whether these knowledge gaps correlate with TB control.

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Family support and community respect for community health workers and the association of these with CHW productivity and clinic health care utilization

Journal of Global Health Reports ◽

10.29392/001c.12314 ◽

2020 ◽

Author(s):

Nabamallika Dehingia ◽

Holly Shakya ◽

Dharmendra Chandurkar ◽

Katherine Hay ◽

Arnab Dey ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Community Health ◽

Family Support ◽

Community Health Workers ◽

Health Workers ◽

Care Utilization

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A Randomized Control Trial to Test Effect of Cash Incentives and Training on Active Casefinding for Tuberculosis among Community Health Workers in Nigeria

F1000Research ◽

10.12688/f1000research.53822.1 ◽

2021 ◽

Vol 10 ◽

pp. 1154

Author(s):

Christie Akwaowo ◽

Victor Umoh ◽

Idongesit Umoh ◽

Eno Usoroh ◽

Olugbemi Motilewa ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Case Finding ◽

P Value ◽

Case Detection ◽

High Burden ◽

Cash Incentives ◽

Case Notification ◽

And Training

Background: Case detection for Tuberculosis remains low in high burden communities. Community Health Workers (CHWs) are the first point of contact for many Nigerians in the rural areas and have been found useful in active case finding. This study assessed the effect of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods: A randomised control trial was conducted in three PHC clusters. The intervention Arm (A) received cash incentives for every presumptive case referred. The Training Arm(B) had no cash incentives and the control had neither training nor cash incentives. Case notification rates from the TB program were used to assess the effect of cash incentives on TB case finding. Data was analyzed using Graph Pad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Mean increases in case notification rates was calculated Statistical significance was set as P=0.05. Results: The intervention identified 394 presumptive TB cases, contributing 30.3% of all presumptive cases notified in the LGAs. Findings also showed an increase of 14.4% (ꭓ2=2.976, P value=0.2258) in case notification rates for the Arm A that received cash incentives alongside training, there was also an increase of 7.4% (ꭓ2= 1.999, P value=0.1575) in Arm B that received Training only. Secondary outcomes indicated a 144.8%(ꭓ2= 4.147, P value=0.1258) increase in community outreaches conducted in the Arm that were given cash incentives. Conclusion: The study demonstrated an increase in TB control activities of case notification and outreaches among community health workers that received cash incentives and training. These findings support the use training and cash incentives for CHWs in high burden TB settings to improve TB case detection rates.

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9 The Contribution of Community Health Workers to the Implementation of Comprehensive Primary Health Care in Rural Settings, Iran

Revitalizing Health for All ◽

10.3138/9781487513887-014 ◽

2017 ◽

pp. 185-201

Keyword(s):

Health Care ◽

Primary Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Primary Health ◽

Comprehensive Primary Health Care ◽

Rural Settings

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Designing Pedagogically-Driven Approaches to Technology-Enhanced Learning for Community Health Workers

10.1093/oso/9780198866244.003.0006 ◽

2021 ◽

pp. 87-100

Author(s):

Shobhana Nagraj

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Educational Interventions ◽

Training Programme ◽

Technology Enhanced Learning ◽

Theoretical Approaches ◽

Teaching Modality ◽

Enhanced Learning ◽

And Training

Technology-enhanced learning (TEL) is well established as a teaching modality. However, there is a lack of evidence for the pedagogical approaches used to design TEL for community health workers (CHWs). This chapter highlights the importance of contextualizing CHW learning within the wider health system. Theoretical approaches to consider when designing a TEL-based education and training programme for CHWs are presented, with practical examples of how these approaches might be most appropriately embedded in the delivery of CHW training. Finally, a framework for the design of pedagogically-grounded TEL-based learning for CHWs is presented, which may be used to help guide the design of TEL-based educational interventions for CHWs.

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