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Kåks P, Stansert Katzen L, Målqvist M, Bergström A, Herzig van Wees S. Implementing a social innovation for community-based peer support for immigrant mothers in Sweden: a mixed-methods process evaluation. Front Public Health 2024; 11:1332738. [PMID: 38283291 PMCID: PMC10821792 DOI: 10.3389/fpubh.2023.1332738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction A South African social innovation based on peer support for mothers was contextualized in southern Sweden. The objective of the project was to support expectant women and mothers of young children in immigrant communities to access public services that would benefit maternal and child health. This study aimed to assess how the intervention was implemented, what the contextual barriers and facilitators were, and how the implementation was perceived by those who delivered and received it. Methods The study used mixed methods with a convergent parallel design and followed the Medical Research Council guidance on process evaluations of complex interventions. Semi-structured interviews (n = 19) were conducted with peer supporters, client mothers, and key stakeholders involved in the intervention. The qualitative data were analyzed using content analysis. Quantitative data on peer supporters' activities were collected during contacts with client mothers and were presented descriptively. Results The five peer supporters had 1,294 contacts with client mothers, of which 507 were first-time contacts. The reach was perceived as wide, and the dose of the intervention was tailored to individual needs. Barriers to implementation included community mistrust of social services, norms on gender roles and parenting, and funding challenges. The implementation was facilitated by the organization's reputation, network, experience, and third-sector affiliation. Peer supporters tended to prioritize linking clients to other services over the educational components of the intervention, sometimes doing more than what was originally planned. Implementation strategies used included building trust, using multiple outreach venues, using internal support structures, and providing practical assistance as an entry point to comprehensive psychosocial support. The personal connection between peer supporters and clients was highly valued, and the building of relationships enabled them to address sensitive topics. Peer supporters sometimes experienced a blurred line between professional and personal roles. Conclusions Peer supporters used a variety of strategies to navigate identified barriers and facilitators. Trust was central both as a contextual factor and a strategy for implementation. It is valuable to maintain a balance between flexibility and adherence to the function of peer supporters. Further research is needed to evaluate the effects of the intervention.
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Affiliation(s)
- Per Kåks
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Linnea Stansert Katzen
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Bergström
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sibylle Herzig van Wees
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Obasanjo I, Scott A, Griffin M, Agyemang-Duah A, Westhoff C, Toney S, Shelton P. Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia. Community Health Equity Res Policy 2024; 44:219-227. [PMID: 36716267 DOI: 10.1177/2752535x231154051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US. METHOD In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10 years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme. RESULTS CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client's challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members. CONCLUSION The information garnered from the CHWs would be useful in designing CHW programs at other health districts.
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Affiliation(s)
- Iyabo Obasanjo
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Alison Scott
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Monica Griffin
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Amma Agyemang-Duah
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Charlie Westhoff
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Stephanie Toney
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Patrice Shelton
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
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Pallikkuth R, Manoj Kumar T, Dictus CT, Bunders-Aelen JFG. Design and Evaluation of Peer Supervision for Community Mental Health Workers: A Task-Shifting Strategy in Low-Resource Settings. Community Ment Health J 2024; 60:131-147. [PMID: 37679654 PMCID: PMC10799819 DOI: 10.1007/s10597-023-01161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/17/2023] [Indexed: 09/09/2023]
Abstract
The use of Lay Mental Health Workers (LMHWs) to tackle the treatment gap in low-resource settings is well established, and although they often receive training, the potential of proper supervision to improve outcomes remains untapped. Indeed, given the strain on expert resources, peer-supervision models based on supervisors' seniority of work experience have significant potential especially in relation to community knowledge and embedding of LMHWs. This study summarizes the evaluation of a pilot program for peer supervision on the basis of Social Cognitive Theories of Self-Efficacy for LMHWs in Kerala, India. Two experienced LMHWs worked as supervisors for a total of 12 LMHWs over the course of a year. These participants were subsequently interviewed to analyze their experiences in order to evaluate the potential of peer supervision and distil relevant information to improve future training of LMHWs. The findings include improved performance and emotional support for the participants.
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Affiliation(s)
- Rekha Pallikkuth
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - T Manoj Kumar
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Claudia T Dictus
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
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Ndu M, Andoniou E, McNally S, Olea Popelka F, Tippett M, Nouvet E. The experiences and challenges of community health volunteers as agents for behaviour change programming in Africa: a scoping review. Glob Health Action 2022; 15:2138117. [PMID: 36314363 PMCID: PMC9629118 DOI: 10.1080/16549716.2022.2138117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Community health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a synthesis of key challenges and considerations that can inform efforts to reduce attrition and improve the sustainability of community health volunteers in Africa. This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist to achieve the objectives. A comprehensive search of six databases returned 2140 sources. After screening, 31 peer-reviewed studies were selected for final review. Analytical themes were generated based on the reviewers’ extraction of article data into descriptive themes using an inductive approach. In reviewing community health volunteers’ accounts of providing health services, five key challenges become apparent. These are: (1) challenges balancing work responsibilities with family obligations; (2) resource limitations; (3) exposure to stigma and harassment; (4) gendered benefits and risks; and (5) health-system level challenges. This scoping review highlights the extent of challenges community health volunteers must navigate to provide services in communities. Sustained commitment at the national and international level to understand the lived experiences of community health volunteers and mitigate common stressors these health actors face could improve their performance and inform future programs.
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Affiliation(s)
- Mary Ndu
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Ellena Andoniou
- Faculty of Health Science, Western University, London, ON, Canada
| | - Sorcha McNally
- Faculty of Health Science, Western University, London, ON, Canada
| | - Francisco Olea Popelka
- Department of Pathology and Laboratory Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Marisa Tippett
- Research & Scholarly Communications Librarian, Western Libraries, Western University, London, ON, Canada
| | - Elysée Nouvet
- Faculty of Health Science, Western University, London, ON, Canada
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Eubank TN, Beukes EW, Swanepoel DW, Kemp KG, Manchaiah V. Community-based assessment and rehabilitation of hearing loss: A scoping review. Health Soc Care Community 2022; 30:e1541-e1559. [PMID: 35648649 DOI: 10.1111/hsc.13846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Although the World Health Organization (WHO) recommends the use of a Community-Based Rehabilitation (CBR) model, little is known about how CBR has been applied in the hearing healthcare setting. The purpose of this scoping review was to identify and describe studies on Community-Based Hearing Rehabilitation (CBHR) programs within the applied context. The review was conducted in September 2020 with updated searches in November 2021 according to the Joanna Briggs Institute (JBI) methodology and reported using the guidelines and checklist for Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews (PRISMA-ScR). Fifty-nine peer-reviewed research articles were included in the review. A narrative synthesis was conducted to map out the types of CBHR programs. Studies were classified into audiological themes: awareness, screening and assessment of hearing in newborn/infants, children and adults, training of community health workers, rehabilitation, cost-effectiveness and describing the service delivery models. Further categorisation was made based on CBR aspect matrices for each study. Most of the studies come from high-income countries in North America and Europe. CBHR studies predominantly focused on creating awareness, training and hearing screenings and/or assessments in communities and evaluating effectiveness in providing knowledge and access to hearing health services in rural or underserved communities. Further work is needed to examine the outcomes and effectiveness of CBHR using controlled studies. Moreover, more work is needed in low- and middle-income countries where the application of CBHR is critical for increased access and affordability.
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Affiliation(s)
- Taylor N Eubank
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, Colorado, USA
| | - Eldré W Beukes
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, Colorado, USA
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - De Wet Swanepoel
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, Colorado, USA
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
| | - Kaley G Kemp
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
| | - Vinaya Manchaiah
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, Colorado, USA
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, Colorado, USA
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Stansert Katzen L, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, Rotheram-Borus MJ, le Roux I, Mbewu N, Tomlinson M. Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa. Res Nurs Health 2022; 45:380-389. [PMID: 35184308 PMCID: PMC9271365 DOI: 10.1002/nur.22220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/13/2021] [Accepted: 02/01/2022] [Indexed: 08/20/2023]
Abstract
Access to healthcare in developing countries remains a challenge. As a result, task-shifting to community health workers (CHWs) is increasingly used to mitigate healthcare worker shortages. Although there is solid evidence of CHW program effectiveness, less is known about CHWs' experiences of becoming and then working daily as CHWs-information that should play an important role in the design of CHW programs. We examined the experiences of a group of CHWs working in a government-run CHW program in South Africa's rural Eastern Cape Province. Semistructured qualitative interviews (N = 9) and focus groups (N = 2) focusing on motivations for becoming a CHW and experiences of working as CHWs were conducted and thematically analyzed. Three themes were identified: (1) becoming a CHW, (2) facing challenges in the field, and (3) gaining community acceptance through respect and legitimacy. In this study, CHWs were motivated by altruism and a desire to help their community. They faced a range of challenges such as limited training, lack of supervision, equipment shortages, logistical issues, and clinics with limited services. Respect and legitimacy through community acceptance and trust is crucial for effective CHW work. CHWs in this study described how confidentiality and their own persistence facilitated the process of gaining respect and legitimacy. CHWs have a unique knowledge of contexts and requirements for successful programs and greater efforts are needed to include their perspectives to improve and develop programs. Recognition is needed to acknowledge the significant personal input required by CHWs for programs to be successful.
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Affiliation(s)
- Linnea Stansert Katzen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Elaine Dippenaar
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Vuyolwethu Notholi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Karl le Roux
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, California, USA
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Wogrin C, Willis N, Mutsinze A, Chinoda S, Verhey R, Chibanda D, Bernays S. It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV. PLoS One 2021; 16:e0248018. [PMID: 33657185 PMCID: PMC7928463 DOI: 10.1371/journal.pone.0248018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. METHODS We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18-24) from across 10 intervention districts and audio recorded 200 of the peer supporters' monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. RESULTS A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. CONCLUSION Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.
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Affiliation(s)
| | | | | | | | - Ruth Verhey
- Friendship Bench, Avondale, Harare, Zimbabwe
| | - Dixon Chibanda
- Friendship Bench, Avondale, Harare, Zimbabwe
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Bernays
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Public Health, University of Sydney, Sydney, Australia
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Laurenzi CA, Skeen S, Coetzee BJ, Notholi V, Gordon S, Chademana E, Bishop J, Tomlinson M. Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural south African home visiting program. Int J Equity Health 2021; 20:32. [PMID: 33436011 PMCID: PMC7805205 DOI: 10.1186/s12939-020-01377-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 11/12/2022] Open
Abstract
Background Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa. Methods We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed. Results We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice. Conclusions These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients’ voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01377-z.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa. .,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Bronwynè J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Emma Chademana
- One to One Africa Children's Fund, Cape Town, South Africa
| | - Julia Bishop
- One to One Africa Children's Fund, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.,School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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