Realities and experiences of community health volunteers as agents for behaviour change: evidence from an informal urban settlement in Kisumu, Kenya

Rose Evalyne Aseyo,Kelly K Baker,Emily Davis,Damaris Nelima,Kerry Scott,Oliver Cumming,Jane Mumma,Robert Dreibelbis

doi:10.1186/s12960-018-0318-4

Abstract

BackgroundCommunity health workers play an important role in health service delivery and are increasingly involved in behaviour change interventions, including for hygiene-related behaviour change. However, their role and capacity to deliver behaviour change interventions, particularly in high-density urban settlements, remain under-researched. This study examines the behaviour change-related activities of community health volunteers (CHVs)—community health workers affiliated with the Kenyan Ministry of Health—in a peri-urban settlement in Kenya, in order to assess their capabilities, opportunities to work effectively, and sources of motivation.MethodsThis mixed-methods study included a census of 16 CHVs who work in the study area. All CHVs participated in structured observations of their daily duties, structured questionnaires, in-depth interviews, and two focus group discussions. Structured data were analysed descriptively. Thematic content analysis was followed for qualitative data. Results were synthesized and interpreted using the capability, opportunity, motivation for behaviour change framework, COM-B.ResultsIn addition to their responsibilities with the Ministry of Health, CHVs partnered with a range of non-governmental organizations engaged in health and development programming, often receiving small stipends from these organizations. CHVs reported employing a limited number of behaviour change techniques when interacting with community members at the household level. Capability: While supervision and support from the MOH was robust, CHV training was inconsistent and inadequate with regard to behaviour change and CHVs often lacked material resources necessary for their work. Opportunity: CHVs spent very little time with the households in their allocated catchment area. The number of households contacted per day was insufficient to reach all assigned households within a given month as required and the brief time spent with households limited the quality of engagement. Motivation: Lack of compensation was noted as a demotivating factor for CHVs. This was compounded by the challenging social environment and CHVs’ low motivation to encourage behaviour change in local communities.ConclusionsIn a complex urban environment, CHVs faced challenges that limited their capacity to be involved in behaviour change interventions. More resources, better coordination, and additional training in modern behaviour change approaches are needed to ensure their optimal performance in implementing health programmes.

Highlights

Community health workers play an important role in health service delivery and are increasingly involved in behaviour change interventions, including for hygiene-related behaviour change
For Community health volunteer (CHV) to be effective as agents of behaviour change promotion, there is a need to re-evaluate the standard workload of CHVs in peri-urban informal settings, operationalize training, and revitalize the engagement and collaboration of partners
Results are presented under the following sub-sections: CHV general characteristics, current CHV approaches to behaviour change, and CHV capability, opportunity, and motivation in delivering behaviour change interventions at the community or household level

Summary

Introduction

Community health workers play an important role in health service delivery and are increasingly involved in behaviour change interventions, including for hygiene-related behaviour change. CHWs can be usefully defined as community members with an in-depth understanding of community values, local culture, and language, who are selected by the community through a participatory process, have undergone standardized training, are qualified/certified to provide a defined package of health promotion and services at the community level, have formal linkages to health system, and are recognized as part of the health workforce [13] Due to their potential reach and proximity to high-need populations, CHWs contribute to improving community health in many ways by diagnosing and treating illnesses (such as malaria, pneumonia, and diarrhoea), making referrals to health facilities, providing health education, conducting nutrition surveillance, collecting vital events data, assisting with immunization, and providing other aspects of maternal and child health care and family planning services [14, 15].

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