PDF(Pubmed)
Abstract：
BACKGROUND: Community health workers (CHWs) bridge the primary health care (PHC) system and communities by providing care in the household. In Malawi, few studies have examined the perspective of users of household-level CHW services, in remote areas, to understand CHW\'s role in community-based PHC.
OBJECTIVE: To explore perspectives of community and facility stakeholders on the enablers and challenges of the CHW role in community-based PHC in Neno District.
METHODS: The study was conducted in the Neno District health facilities, namely, Ligowe, Dambe, Chifunga, and Zalewa.
METHODS: We conducted eight focus group discussions (FGDs) with purposively sampled community members and conveniently sampled facility stakeholders. Data were transcribed and analysed thematically through an adapted COM-B model of behaviour change.
RESULTS: Three main themes of perceived behaviour change within the CHW role were identified: (1) capacity - the CHW programme aids health education and promotion within the community; (2) opportunity - the CHW programme facilitates community-based PHC and linkage to the facility; and (3) motivation - the CHW programme enablers and challenges in providing community-based PHC.
CONCLUSIONS: Community health workers enrich community-based PHC delivery through health education, timely access to care, and linking communities to the facility. Optimising workload and programme support is critical for the help of CHWs. Further studies are required to address programme and cultural challenges to enhance positive health-seeking behaviours.Contribution: This study provides contextual knowledge for further research on bringing together spiritual and formal health practices and considering the cultural background when planning for health interventions in remote areas.
OBJECTIVE: To explore perspectives of community and facility stakeholders on the enablers and challenges of the CHW role in community-based PHC in Neno District.
METHODS: The study was conducted in the Neno District health facilities, namely, Ligowe, Dambe, Chifunga, and Zalewa.
METHODS: We conducted eight focus group discussions (FGDs) with purposively sampled community members and conveniently sampled facility stakeholders. Data were transcribed and analysed thematically through an adapted COM-B model of behaviour change.
RESULTS: Three main themes of perceived behaviour change within the CHW role were identified: (1) capacity - the CHW programme aids health education and promotion within the community; (2) opportunity - the CHW programme facilitates community-based PHC and linkage to the facility; and (3) motivation - the CHW programme enablers and challenges in providing community-based PHC.
CONCLUSIONS: Community health workers enrich community-based PHC delivery through health education, timely access to care, and linking communities to the facility. Optimising workload and programme support is critical for the help of CHWs. Further studies are required to address programme and cultural challenges to enhance positive health-seeking behaviours.Contribution: This study provides contextual knowledge for further research on bringing together spiritual and formal health practices and considering the cultural background when planning for health interventions in remote areas.
摘要：
背景：社区卫生工作者（CHW）通过在家庭中提供护理来桥接初级卫生保健（PHC）系统和社区。在马拉维,很少有研究考察家庭级CHW服务用户的观点，在偏远地区,了解CHW在基于社区的PHC中的作用。
目的：探讨社区和设施利益相关者对内诺区社区PHC中CHW角色的推动者和挑战的看法。
方法：这项研究是在内诺区卫生机构进行的，即,Ligowe,该死,Chifunga,还有Zalewa.
方法：我们进行了八次焦点小组讨论（FGD），有目的地抽样的社区成员和方便地抽样的设施利益相关者。通过适应的行为变化COM-B模型对数据进行主题转录和分析。
结果：确定了CHW角色中感知到的行为变化的三个主要主题：（1）能力-CHW计划有助于社区内的健康教育和促进；（2）机会-CHW计划促进基于社区的PHC并与设施建立联系；（3）动机-CHW计划在提供基于社区的PHC方面的推动力和挑战。
结论：社区卫生工作者通过健康教育丰富以社区为基础的PHC分娩，及时获得护理，并将社区与设施联系起来。优化工作量和计划支持对于CHW的帮助至关重要。需要进一步研究以应对方案和文化挑战，以加强积极的寻求健康的行为。贡献：本研究为进一步研究提供了背景知识，以将精神和正式的健康实践结合在一起，并在计划偏远地区的健康干预措施时考虑文化背景。
目的：探讨社区和设施利益相关者对内诺区社区PHC中CHW角色的推动者和挑战的看法。
方法：这项研究是在内诺区卫生机构进行的，即,Ligowe,该死,Chifunga,还有Zalewa.
方法：我们进行了八次焦点小组讨论（FGD），有目的地抽样的社区成员和方便地抽样的设施利益相关者。通过适应的行为变化COM-B模型对数据进行主题转录和分析。
结果：确定了CHW角色中感知到的行为变化的三个主要主题：（1）能力-CHW计划有助于社区内的健康教育和促进；（2）机会-CHW计划促进基于社区的PHC并与设施建立联系；（3）动机-CHW计划在提供基于社区的PHC方面的推动力和挑战。
结论：社区卫生工作者通过健康教育丰富以社区为基础的PHC分娩，及时获得护理，并将社区与设施联系起来。优化工作量和计划支持对于CHW的帮助至关重要。需要进一步研究以应对方案和文化挑战，以加强积极的寻求健康的行为。贡献：本研究为进一步研究提供了背景知识，以将精神和正式的健康实践结合在一起，并在计划偏远地区的健康干预措施时考虑文化背景。
