Abstract
BackgroundmHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries’ perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described.MethodsA qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose.FindingsThe mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries’ views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS.ConclusionsmHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members.
Highlights
Community health workers (CHWs) are an integral component of the health workforce in low- and middle-income countries (LMICs), providing last mile services, especially in underserved areas [1]
While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors
Anganwadi Workers (AWWs) in Madhya Pradesh were an average of 45 years old and those in Bihar were 38
Summary
Community health workers (CHWs) are an integral component of the health workforce in low- and middle-income countries (LMICs), providing last mile services, especially in underserved areas [1]. The adoption of Astana Declaration in 2018 reiterated the importance of primary health care and community health systems in improving population health [5]. CHW programs are considered to be part of long-term investment in strengthening community-oriented health systems and achieving universal health coverage (UHC) and health-related sustainable development goals (SDGs) in many LMICs [6]. CHWs form a crucial link between health systems and the communities they serve by improving access to and coverage of health services. This is supported by evidence demonstrating the effectiveness of CHWs in delivering a range of preventive, promotive, and curative services across a range of health domains [7,8,9]. Important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described
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