Abstract
Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12-13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.
Highlights
Community health workers (CHWs) are central to efforts to reduce neonatal mortality in many lowincome settings,[1] and prenatal or postnatal home visits by community health worker (CHW) are a key component of their role.[2]
In Ethiopia, we focus on health extension workers (HEW) and the Health Development Army (HDA) leaders who were supported by the Last Ten Kilometers (L10K) program, and we compare our findings with those from northeast Nigeria around the role of community volunteers supported by the Society for Family Health (SFH)
We did not achieve the planned diversity in place of delivery possibly because we were working in more accessible areas, in areas where CHWs were active, and with women who had received at least 1 visit by a CHW
Summary
Community health workers (CHWs) are central to efforts to reduce neonatal mortality in many lowincome settings,[1] and prenatal or postnatal home visits by CHWs are a key component of their role.[2]. The counseling approach often focuses on informationcentric interpersonal communication, and it is informed by theoretical models developed in high-income settings.[5,6] These theories are driven by constructs such as rationality, autonomy, self-interest, and material progression. This approach is exemplified in a recent review
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
