Utilization Of Community-based Services Research Articles

Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade

ABSTRACT Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.

Utilization and Satisfaction of Community-based Health Care Services among Older Adults

The COVID-19 pandemic has a significant impact on the capacity of health systems to continue to provide critical services. As healthcare systems around the world face a growing demand for care for patients with COVID-19, it is vital to maintain preventive and curative services, especially for the most vulnerable populations, the elderly and the elderly living with chronic diseases. The purpose of this study was to determine the level of health service utilization and satisfaction of older adults amidst COVID-19 pandemic. The study used a descriptive- correlational research design that was conducted in a selected barangay in the city of Caloocan. The purposive and snowball sampling method was used to select respondents and must meet the following criteria: elderly between the ages of 60 and 74, and using health care services. The data collection was carried out through a series of questionnaires with an informed consent form through online platforms. Based from the data gathered, the strength of the relationship is indicated by the correlation coefficient with a score of. 795, which is greater than 0.70 shows a high correlation between the two variables. This means that when the level of utilization of community-based services of the respondent is high, their level of satisfaction with health care services increases as well. Overall, it is important to prioritize the level of utilization and satisfaction in community-based healthcare among older adults as it is used as an indicator for measuring the quality of healthcare. The level of utilization among older adults is inclined to their level of satisfaction, in which respondents are highly satisfied with their usage of services in terms of accessibility, availability and affordability of the community-based services. Moreover, demographic profile of respondents has no significant difference, which indicates that respondent’s level of satisfaction in community-based services is affected by their level of utilization of services in their barangay health center. Health services, if used by the elderly, can lead to satisfaction. Therefore, the promotion of the various health services is strongly encouraged to reach not only a few, but the whole population.

Urban-Rural Disparities in the Association Between Home- and Community-Based Service Utilization and Levels of Disability Among Chinese Older Adults With Disabilities.

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban-rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban-rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%).

Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study

BackgroundAs global aging intensifies, older adults with chronic diseases are of increasing concern. Home and community-based services (HCBSs) have been proven to promote self-rated health (SRH) in older adults, but no research explored the associations between the use of overall HCBSs, three different types of HCBSs (health care, daily care, and social support services) and SRH among older adults with chronic diseases. Consequently, this study applies a national publicly available database to examine these associations among older adults with chronic diseases.Methods8,623 older adults with chronic diseases (≥ 60 years old) were included in this study. SRH was evaluated applying a concise question with a 1 − 5 scale. HCBSs utilization was assessed through the question, “What kind of HCBSs were used in the community?”. Univariate general linear regression models aimed to compare the mean values of SRH in terms of HCBSs utilization in each group. This study is a cross-sectional study design and the relationship between HCBSs utilization and SRH was assessed by multilevel linear regression.ResultsThe mean score for SRH among the respondents was 3.19, of whom 20.55% used one or more HCBSs, 19.47% utilized health care services, 2.44% utilized social support services, and only 0.55% utilized daily care services. The use of HCBSs was found to be linked to SRH among older adults with chronic diseases (β = 0.085, SE = 0.025, p < 0.001). SRH among older adults with chronic diseases was strongly linked to the use of health care and social support services (β = 0.068, SE = 0.025, p < 0.001; β = 0.239, SE = 0.063, p < 0.001, respectively). However, there was no significant association between the use of daily care services and SRH among older adults with chronic diseases.ConclusionThis study revealed that HCBSs utilization was positively and significantly linked to SRH in Chinese older adults with chronic diseases. Furthermore, this study supposes the low utilization of social support and daily care services may be due to a mismatch between supply and demand. The government should offer the targeted HCBSs for older adults with chronic diseases according to their unique features to enhance their health status.

Examining Utilization of Formal Supports and Related Impacts on Overall Well-Being Among East Asian American Family Caregivers of Persons With Dementia: A Mixed-Methods Study.

Although East Asian American family caregivers are known to underutilize formal support services, there is a lack of evidence regarding the associations of formal service utilization with caregivers' well-being. This study examined the prevalence of different types of home-and community-based formal service utilization among Korean and Chinese American family caregivers of persons with dementia and how utilization of such services was associated with their well-being. We also explored their overall experience in accessing and utilizing formal dementia support services and programs. We employed a convergent mixed-methods study design. In a convenience sampling method, we recruited 62 family caregivers. Logistic regression and thematic analysis were utilized to analyze data. The results showed in-home services were mostly utilized among family caregivers of these ethnic groups. Out of 9 different support services, those who utilized nutrition programs and case management were more likely to report higher overall well-being. Four themes were developed: (1) awareness of formal support services but uncertainty on how to access them, (2) language barriers imposing additional challenges in accessing formal support services, (3) traveling to access culturally appropriate services, and (4) desire for culturally tailored medical and long-term care services. Findings from this study suggest the importance of case management services to overcome barriers to accessing and utilizing a wide range of formal support services and provision of culturally appropriate food in formal support services to increase East Asian American family caregivers' utilization of long-term care services.

The relationship between home and community-based healthcare services utilization and depressive symptoms in older adults in rural China: a moderated mediation model

BackgroundStudies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults.MethodsData were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes’ PROCESS macro (Model 7).ResultsHCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents.ConclusionThe results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.

205 Perceived Needs and Access to Community-based Dementia Resources in the Rural Deep South

OBJECTIVES/GOALS: The goal of this project is to investigate dementia caregivers’ needs, barriers to access, and current utilization of community-based dementia-care services in Alabama, and how these vary across rural/urban settings and racial groups. METHODS/STUDY POPULATION: We partnered with Marketry Inc. to recruit and conduct interviews among three groups: dementia caregivers, healthcare providers, and aging services representatives. We recruited caregivers from dementia support groups and aging services in 2 rural and 2 urban Alabama counties. Purposive and snowball sampling was used to recruit healthcare providers and aging services representatives. Interviews were conducted by trained Marketry staff, recorded, and transcribed verbatim. Rapid content analysis was conducted by three investigators using the Social Determinants of Health as a coding framework to assess patterns in barriers and facilitators to utilizing community-based dementia resources. RESULTS/ANTICIPATED RESULTS: We interviewed 5 healthcare providers, 32 caregivers, and 15 aging services representatives. Providers thought that the process of memory loss care is not streamlined and they lack key information necessary to fulfill their role. Caregivers expressed a need for more dementia education, social connection, and access to financial resources. Aging services agencies need more funding and volunteers to sustain community-based dementia services. Dementia resources, like memory clinics, were more available in urban than in rural counties. African-American caregivers mentioned a reluctance to accept outside help for taking care of their loved ones with dementia, potentially due to distrust. DISCUSSION/SIGNIFICANCE: There is a need for more accessible dementia services in rural AL and a need to build service trust and familiarity, especially among African-American caregivers. Future research should develop tools for providers and caregivers to start conversations and increase awareness of service availability.

EVALUATING EXPENDITURES AND UTILIZATION OF OHIO'S INTEGRATED MEDICARE AND MEDICAID PROGRAM

Abstract In 2014, 29 of 88 Ohio counties implemented MyCare, which integrated Medicare and Medicaid for dually eligible Ohioans. Using an intent-to-treat, difference-in-difference framework we examined medical expenditures and utilization associated with the implementation of MyCare. Specifically, we compared dually eligible Ohioans in MyCare counties to those in non-MyCare counties from 2012 to 2018. Overall medical expenditures were lower in the MyCare counties post implementation compared to non-Mycare counties, with most of the difference attributed to Medicaid. The effects were larger for individuals in the community compared to long-term services and supports (LTSS) users. The implementation of MyCare is associated with a decrease in the use of nursing homes, a large increase in hospice, and among LTSS users not in a nursing home decreases in the utilization of home and community-based services. Interestingly, the proportion of individuals in MyCare counties classified as an LTSS user increased after the implementation of MyCare.

Factors associated with the utilization of community-based health services among older adults in China\u2014an empirical study based on Anderson\u2019s health behavior model

Taking the modified Anderson health behavior model as the analysis framework and relying on 1136 empirical research data of S District in Foshan City, Guangdong Province of China, this study explores the influence of predisposing factors, enabling factors and need factors on the utilization of community-based health services among older adults in China. The results show that three variables have a significant impact on the use of family health services, which are whether the pension is the main source of living, income surplus, and major expenditure items. Seven variables have a significant impact on the use of preventive health services, which are household registration type, the basic endowment insurance coverage, the nature of the working unit before retirement, the self-rated health status, chronic diseases, self-care ability in daily life, and preventive health care needs.

Factors Associated With Community Based Health Insurance Healthcare Service Utilization of Households in South Gondar Zone, Amhara, Ethiopia. A Community-Based Cross-Sectional Study.

In Ethiopia, community-based health insurance was implemented to promote equitable access to sustainable quality health care and increase financial protection. The purpose of this study was to identify factors associated with community-based Health Insurance, Health Care Service Utilization of Households in the South Gondar Zone. A community-based cross-sectional study was employed. Data were collected among 619 randomly selected households in the south Gondar zone. Chi-square and binary logistic regression analyses with a P-Value of less than .05 were used to determine the association. Out of the total households, 511(82.6%) were using the CBHI scheme for health care service utilization. Residence, marital status, education level, occupation status, family size, presence of under-five children in the household, presence of elders in the households, nearest health institution, presence of chronic illness in the household’s, time taken to reach health institution, an attitude of a household were the determinant factors of community-based health insurance scheme health care service utilization of households. It is recommended that the local, regional and national governments, policymakers on optimal actions, NGOs, and other supporting organizations shall improve or scale-up the scheme by providing awareness to the community based on these significant factors and the attitude of households.

Challenges to the utilization of Community-based Health Planning and Services: the views of stakeholders in Yendi Municipality, Ghana

BackgroundThe Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored implementation and utilization challenges of the CHPS programme in the Northern Region of Ghana.MethodsThis was an observational study that employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system.ResultsThe participants reported poor clinical attendance including delays in seeking health care, low antenatal and postnatal care visits. The barriers of the CHPS utilization include lack of transportation, poor road network, cultural beliefs (e.g. taboos of certain foods), proof of women’s faithfulness to their husbands and absence of health workers. Other challenges were poor communication networks during emergencies, and inaccessibility of ambulance service. In seeking health care, insured members of the national health insurance scheme (NHIS) still pay for services that are covered by the NHIS. We found that the CHPS compounds lack the capacity to sterilize some of their equipment, lack of incentives for Community Health Officers and Community Health Volunteers and inadequate infrastructures such as potable water and electricity. The study also observed poor coordination of interventions, inadequate equipment and poor community engagement as setbacks to the progress of the CHPS policy.ConclusionsClinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The CHPS barriers include transportation, poor road network, cost of referrals, cultural beliefs, inadequate equipment, lack of incentives and poor community engagement. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.

Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review.

The Ethiopian Federal Ministry of Health and partners have scaled up integrated community case management (iCCM) and community-based newborn care (CBNC), allowing health extension workers (HEWs) to manage the major causes of child and newborn death at the community level. However, low service uptake remains a key challenge. We conducted a scoping review of peer-reviewed and grey literature to assess barriers to the utilization of HEW services and to explore potential solutions. The review, which was conducted to inform the Optimizing the Health Extension Program project, which aimed to increase the utilization of iCCM and CBNC services, included 24 peer-reviewed articles and 18 grey literature documents. Demand-side barriers to utilization included lack of knowledge about the signs and symptoms of childhood illnesses and danger signs; low awareness of curative services offered by HEWs; preference for home-based care, traditional care, or religious intervention; distance, lack of transportation and cost of care seeking; the need to obtain husband’s permission to seek care and opposition of traditional or religious leaders. Supply-side barriers included health post closures, drug stockouts, disrespectful care and limited skill and confidence of HEWs, particularly with regard to the management of newborn illnesses. Potential solutions included community education and demand generation activities, finding ways to facilitate and subsidize transportation to health facilities, engaging family members and traditional and religious leaders, ensuring consistent availability of services at health posts and strengthening supervision and supply chain management. Both demand generation and improvement of service delivery are necessary to achieve the expected impact of iCCM and CBNC. Key steps for improving utilization would be carrying out multifaceted demand generation activities, ensuring availability of HEWs in health posts and ensuring consistent supplies of essential commodities. The Women’s Development Army has the potential to improving linkages between HEWs and communities, but this strategy needs to be strengthened to be effective.

Improving Aging in Place for Older Adults with Low Incomes: Perspectives of Home Health Aides

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk for nursing home admission. Home health aides (HHAs) can help older adults to age in place by optimizing function and engaging them in routine physical activity. Despite this potential role, little is known about HHAs’ perspectives on how to facilitate aging in place for this population. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs working in Philadelphia and New Jersey. Transcripts were analyzed using qualitative thematic analysis. HHAs described wearing multiple hats and pushing the boundaries of their role as a HHA to provide a “comfortable and safe” environment through nursing and emotional support. Many HHAs shared that they serve as surrogate family, often spending more time in clients’ homes than family members or other healthcare providers. This unique position provides HHAs with valuable insights into clients’ changing health which allows them to detect early warning signs of clients’ functional and cognitive decline, including falls, depression, and confusion. HHAs noted several factors that worsened clients’ decline including a lack of adaptive equipment, social isolation, and limited HHA input into clients’ care plans. They also pointed to factors that facilitated clients’ aging in place, including utilization of community-based services, family support, and communication between healthcare team members. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and should be incorporated into care planning and intervention delivery.

Drug use treatment during COVID-19 pandemic: community-based services in Nigeria

ABSTRACT Introduction This study examined the utilization of community-based treatment services by people who use drugs (PWUD) in Nigeria during the lockdown following the COVID-19 outbreak. Methods Data were collected from six drop-in centers (DICs) for PWUD operated by NGOs in four geo-political regions in Nigeria, using a short questionnaire administered to the project managers by e-mail. It sought information on service utilization, sex distribution of service users, types of drugs used, types of services provided, and modes of service delivery for the period of October 2019 to May 2020. Data were analyzed using descriptive statistical techniques. Results Service utilization declined from 375 users in October 2019 to 198 in April, before reaching 321 in May. Female users were more affected by the disruption than men. Cannabis was the drug most commonly used by service users. There were significant gaps in service provision, including limited face-to-face counseling and discontinuation of other services. Conclusion The lockdown limited the range and quality of services provided, and constrained uptake by PWUD. Addressing gender-related barriers, improving funding, and adopting risk reduction measures are recommended for improving service delivery and uptake.

Community-based service requests and utilization among pregnant women incarcerated in jail.

Pregnant incarcerated women represent a unique population in the criminal justice system that has been largely overlooked in terms of their service-related needs. The present study examines 241 pregnant incarcerated women's service requests and preincarceration service utilization related to material help (e.g., food, housing), mental health (e.g., counseling), family services (e.g., home-visiting nurses), and health care (e.g., insurance). A subsample (n = 74) also provided information about service utilization following their release from jail. Analyses examined request and utilization patterns in relation to other sociodemographic risk experiences. Results show that specific risk factors such as age, as well as the accumulation of multiple risk factors, served as barriers to requesting and accessing community-based services. The present study illuminates unique challenges pregnant incarcerated women experience requesting and utilizing services. The results support the use of a gender-responsive, trauma-informed approach to better address the needs of these women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

Background Maternal, Child Health and Nutrition improvement Project is a World Bank-funded project implemented in all then ten regions of Ghana, which aims at improving access and utilization of community-based maternal, child health, and nutrition services in order to accelerate progress. This study is aimed at determining the implementation status of the project in the Eastern region by evaluating the processes involved and identifying implementation barriers from the perspective of implementors. Methods The study was a cross-sectional in design and employed a quantitative data collection approach in ten Community-based Health Planning and Services (CHPS) centres in five districts in the region. The project coordinators and Community Health Officers were interviewed using a structured questionnaire. The project implementation reports at the facility level were reviewed using a checklist. Tertile statistic was used to describe the status of the project implementation. Result The finding from this study indicated “complete implementation status” for maternal, child health, and nutrition activities of the project. However, none of the facilities evaluated had satisfactorily implemented all the governance processes and were therefore rated as “partially complete.” The main implementation barriers emerged from the study were related to restrictions placed on the use of project funds and delays in the fund disbursement to CHPS facilities. Conclusion The evidence gathered from the study showed very good implementation status for community-led maternal and child health service delivery, indicative of a positive response to the guidelines by service providers at the periphery and can have positive impact on the project's objectives and goals. Governance component of the project, however, revealed inadequate alignment with guidelines which might have been influenced by the lack of knowledge as a result of lack of training for implementers. This therefore calls for in-service training and improved supportive supervision at both administrative and service delivery levels.

Perceived quality of primary healthcare services and its association with institutional trust among caregivers of persons diagnosed with a severe mental illness in China.

Low utilization of the family-oriented community rehabilitation services is a threatening challenge facing low- and middle- income countries. Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience. Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non-western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Significant rural-urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas. Mental health nurses or community healthcare workers may provide more family-oriented psycho-education to rural families, and more emotional support to urban families. Wider public anti-stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. Introduction Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community-based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non-western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods This cross-sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice With rural-urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family-oriented psycho-education and emotional support, and promoting public anti-stigma initiatives may be worth consideration.

Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail

BackgroundIndividuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group. MethodsWe implemented a micro-costing approach from the provider’s perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective. ResultsThe average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs. ConclusionsIM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.

Home and Community-Based Service Utilization among Older Adults in Urban China: The Role of Social Capital

ABSTRACT Home and community-based service (HCBS) utilization is considered important for older adults who want to maintain their independence and remain in their communities. This study examined the relationship between structural (e.g., citizenship activities, volunteering) and cognitive (e.g., social trust, a sense of belonging) social capital and HCBS utilization among older Chinese adults. We analyzed survey data from 441 community-dwelling older adults in the Gusu district of the city of Suzhou, China in 2015. Quota sampling was used to select respondents. Negative binomial regression was used within the structural equation modeling framework to test the proposed model for HCBS utilization. Structural social capital had a direct association with HCBS utilization, controlling for predisposing, enabling, and need factors in the model. Further, cognitive social capital showed an indirect association with HCBS utilization via structural social capital. The results suggested the importance of establishing intervention programs that foster structural social capital to promote HCBS utilization.

Community Acceptance and Utilization of Maternal and Community-Based Neonatal Care Services Provided by Health Extension Workers in Rural Sidama Zone: Barriers and Enablers: A Qualitative Study.

PurposeThis study assessed the community acceptance and utilization of maternal and community-based neonatal care services, its barriers, and enablers in southern Ethiopia, 2019.MethodsAn exploratory qualitative study was conducted among mothers, health extension workers, their supervisors and coordinators in four districts of Sidama Zone, Hawassa University Demographic Surveillance Site. An in-depth interview has been carried out with eight health extension workers and eight program coordinators and supervisors, while four focus group discussions were held with eligible mothers. Digital recording was applied to record the interview and discussion followed by transcription and thematic analysis through open code.ResultsStudy findings reveal that services provided by health extension workers at community level for mothers and their children are highly appreciated and recognized by the community. Most of the communities are free from wrong perception regarding the practices. Their performance was better in focused antenatal care, but postnatal care and community-based neonatal care were reported to be insignificant. Knowledge and skills of HEWs was based on their extended experiences. The challenges and opportunities include workload, road inaccessibility, poor supervision, inadequate drugs and equipment supply, shortage of man power and budget at health posts, distance and topography factors of homes from health posts making the visits more difficult, etc. To improve uptake of the services, increasing the number of health extension workers in the heath post, supportive supervision, continuous essential drugsm and medical supplies were suggested by participants.ConclusionThis study shows that services provided by health extension workers for mothers and their neonates are highly appreciated by the community, and there is better change in focused antenatal care services, but postnatal care and sick newborn care are still low. Therefore, maternal and neonatal programs should focus on the postnatal home visits and sick newborn care through solving identified barriers.