Exploring community perceptions of community health workers roles in chronic disease management in western Kenya.

Community perceptions of community health workers (CHWs) and their roles in management for HIV, tuberculosis and hypertension in western Kenya.

Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R, Akinyi J, Braitstein P. PLoS One. 2016 Feb 22;11(2):e0149412. doi: 10.1371/journal.pone.0149412. eCollection 2016.

Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.

Abstract [1]  Full-text [free] access [2] 

Editor’s notes: As community-health workers are becoming an integrated part of the health care systems in Kenya, more information is required on how they are perceived by the communities they serve. This qualitative study explores perceptions on the role of community-health workers in chronic disease management.

Generally, community health workers are well received by the communities. They are perceived as an enabling resource in generating awareness on specific health issues and promoting positive health seeking behaviours. However, some negative perceptions were raised by several study participants, including their inability to maintain confidentiality and their sometimes limited or inaccurate knowledge on specific health issues, due to limited training.

Suggested resources to strengthen the role of community health workers in engaging communities in chronic disease management include additional training. Also information tools e.g. brochures, posters and charts and participation in larger communities’ awareness events e.g. through community gatherings. These findings are particularly useful for other community-health worker programmes to promote positive health seeking behaviours including successful linkage and retention in care.

Africa [6]
Kenya [7]
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