Community Health Assistants Research Articles

Smokeless Tobacco Use Among Rural Women in NE Alabama

Smokeless tobacco use among women living in rural areas is poorly understood and largely ignored. This qualitative study explored the use of smokeless tobacco with 10 participants living in rural areas in Alabama, with the women telling their own stories of use. Themes emerging from interviews included the initiation of use, secrecy, health-risk beliefs, daily-use patterns, and thoughts about quitting. The study results could assist community health nurses in awareness of risks, case finding, and development of community-based prevention strategies. Additional research would help better understanding of the epidemiology of the problem, cultural implications, and practice interventions.

Hope and despair: community health assistants' experiences of working in a rural district in Zambia.

BackgroundIn order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.MethodsA phenomenological approach was used to examine CHAs’ experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach.ResultsPersonal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs’ ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs’ ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA’s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs’ ability to deliver services.ConclusionsProgrammes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

Developing the national community health assistant strategy in Zambia: a policy analysis

BackgroundIn 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process.MethodologyData were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed.ResultsThe strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers.ConclusionsThis paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors’ power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.

CARGAS FÍSICAS E PSÍQUICAS NO TRABALHO DE AGENTES COMUNITÁRIOS DE SAÚDE

Trata-se de uma pesquisa exploratório-descritiva, com abordagem qualitativa em que se aplicou um questionário para a coleta dos dados a 8 agentes comunitários de saúde, no ano de 2009, com o objetivo de identificar as cargas de trabalho físicas e psíquicas. Para a análise dos dados utilizou-se a técnica da análise de conteúdo temática. No que tange às cargas físicas a categoria identificada foi condições de trabalho inadequadas com destaque ao ambiente laboral inadequado e precariedade dos equipamentos de trabalho. Em relação às cargas psíquicas, as categorias identificadas foram falta de reconhecimento por parte de alguns integrantes da comunidades; incapacidade de resolver problemas e dificuldades de relacionamento interpessoal com a comunidade e equipe de saúde da unidade. Esse estudo aponta a necessidade de traçar estratégias de intervenção junto aos agentes e serviço de saúde para promover ações que contribuam para a melhoria da qualidade de vida e saúde destes trabalhadores.

PERCEPÇÕES SOBRE A VIOLÊNCIA NO CENÁRIO DE UMA UNIDADE DE SAÚDE DA FAMÍLIA

Objetivou-se conhecer o contexto da violência no cenário de uma Unidade de Saúde da Família do sul do Brasil. Trata-se de pesquisa qualitativa realizada em 2008 e na qual se utilizou para a coleta de dados a estimativa rápida participativa. Participaram 19 informantes-chave, sendo seis moradores líderes de comunidade, seis agentes comunitários de saúde e sete entre demais integrantes da equipe de saúde. Os dados foram submetidos à análise temática de conteúdo, produzindo-se três categorias: policiamento como fator de segurança; a violência influenciada pelo contexto social e a banalização da violência. Os resultados revelam um entendimento complexo acerca da violência, no entanto, a sua banalização pode ser verificada. A Enfermagem, junto à equipe de saúde, pode contribuir para a redução dos índices de violência, colocando-se na posição de mediadora na construção de uma rede social que identifique, integre, articule e promova ações capazes de melhorar as condições de vida da comunidade.

Reflections on stories and a story/dialogue method in health research

All research can be considered a form of story‐telling, a narrative that begins with a set of questions and assumptions and then follows a convention, based on the researcher’s epistemological and methodological stance, in how the findings are presented and interpreted. Stories also have long history of use in research, as therapy, testament, testimony, data and aesthetic expression. One particular form of the use of stories is a ‘story‐dialogue’ method. This method was first developed to assist community health practitioners in analyzing and theorizing their own practice in order to capture and generalize knowledge about changes in the social/power relations that comprise an important dimension of their work poorly (or not at all) documented through more conventional methods. The story‐dialogue method derives from theoretical roots in international development, feminism, critical pedagogy and critical social science. It is premised on first‐person practice ‘stories’ drafted around a generative theme that are then interrogated in a group process, with questioning deliberately structured to move from description (what?) to explanation (why?), synthesis (so what?) and action (now what?). This article’s reflection of the method incorporates examples of its use and commentaries from practitioners engaged with it. It concludes with a discussion of the methods strengths, weaknesses and potential use within social health research more generally.

Plan estratégico de salud en cárceles federales de Argentina

In the last five years, medical care policies for prisons in the Argentine Federal Penitentiary Service were developed by the previous Medical Care Assistance Office of this Institution to improve primary medical healthcare. Policies were applied with heterogeneous criteria in comparison to the ones established by the Ministry of Health. This may be why I am interested in taking a deeper look at the Argentine experience in order to guarantee human rights, especially access to health for inmates based in the Federal Penitentiary Service. These changes could only be brought about by penal reforms such as reductions in overpopulation, the increase of the number of workers and students among inmates, including socio - cultural activities, the creation of penitentiary treatment programmes for first time inmates, adults, and mental disabilities programmes for inmates with a background of drug abuse, which have represented a great step forward towards the fulfilment of the duties of the state. This novel, integrated approach to medical care policies for imprisoned people is based on the assumed responsibility of the Ministry of Justice together with the Health Ministry, enabling equal access to community health assistance in a closed environment like prison. The reform of medical care policies in federal prisons, leads us to us reflect on the revolutionary changes in public policy management that had not been presented up till now, and that now show a change in direction that the Argentine State has taken towards effective guarantees of human rights for prison inmates.

Working with African American women to develop a cancer literacy assessment tool

Although African American women have a lower incidence of breast cancer, they suffer a 30% higher age-adjusted mortality. Lower health literacy levels diminish women's ability to engage in cancer prevention and detection activities. We conducted a focus group with lay health workers, following their completion of structured literacy assessments. The women's performance established the feasibility and acceptability of incorporating literacy assessments. However, the findings identified perceived limits in existing measures and identified attributes that should be included in cancer-focused literacy assessments. A cancer-specific literacy assessment could assist community health workers in measuring women's functional cancer literacy.

Homeless persons' decisions to accept or reject public health disease-detection services.

The purpose of this study was to describe the factors that homeless persons report as influencing their decisions to utilize or reject a public health disease-detection program. Although there is copious literature on homelessness, few studies report the real-life perspectives of homeless persons toward health or health promotion. A convenience sample of 55 sheltered and street-dwelling homeless persons, who either resided in or were visiting seven shelters in a large northeastern U.S. city, were interviewed. The interview questions focused on the bases for decisions to accept or reject tuberculosis screening. The in-depth semistructured audio-taped interviews were transcribed, coded, and categorized using Ethnograph software. Interviews were analyzed using the constant comparative content analysis methods. The findings describe homeless persons' reasons for accepting or rejecting a tuberculosis-detection service, the prominent role of shelter personnel in recruitment for health-related interventions, and the confidentiality needs of women with children. This information can assist community health practitioners in designing and advertising health-promotion and disease-detection programming.

Developing socio-spatial knowledge networks:: a qualitative methodology for chronic disease prevention

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.

Stress, loneliness, and depression in Taiwanese rural community-dwelling elders

This study examined the stressors and stress levels, loneliness, and depression experienced by Taiwanese rural elders and determine if differences in the level of stress were associated with specific person-environmental characteristics. The relationship between stress and depression was also explored. A total of 201 older rural community residents participated in the study. Findings showed that rural elders experienced a number of stressors related to health and family issues. Differences in the degree of stressfulness of individuals differed by gender, educational level, living arrangement, and socioeconomic status (SES). Findings in this study also showed that there was a high association among stress level, depressive symptoms, and mood status. The findings of this study will assist community health policy-makers in determining the need for health-related services for rural elders experiencing these problems.

Guidelines for the administration of medication in day care centers.

This article addresses guidelines for medication administration that were developed to assist community health nurses when dealing with day care centers. These guidelines focus on legal aspects, safety, storage, and administration of medication to children of different ages who attend day care centers.

Planning and decision making for ambulatory surgery.

There has been rapid growth in the number of ambulatory surgical centers in the United States over the past few years. Yet little research has been done to assist community health planners and surgeons in decision making and planning for ambulatory surgery. In this paper, an analytical framework is developed to assist surgeons in deciding whether to perform a procedure on a ambulatory or an inpatient basis. The Hospital Discharge Survey data collected by the National Center for Health Statistics are also analyzed to investigate their applicability in this analytical framework as well as to aid planners in developing community-wide ambulatory surgery projections. In spite of the limitations on the available data, the models developed here suggest possible future avenues for planning ambulatory surgeries.