Trained Community Health Workers Research Articles (Page 1)

The sea nomads of Sabah, are stateless maritime communities whose lives remain deeply intertwined with the ocean. Despite their rich cultural heritage, they face enduring socio-legal and health inequities, mainly stemming from historical displacement, marginalisation, and the absence of official citizenship. This narrative review synthesises literature on the historical development, legal frameworks, and healthcare access challenges affecting these communities in Sabah, Malaysia. Drawing upon academic publications, government reports, and grey literature, the study employs Levesque et al.’s (2013) healthcare access framework to analyse the barriers sea nomads encounter in perceiving, seeking, reaching, affording, and engaging with healthcare services. The findings highlight that entrenched cultural beliefs, lack of legal documentation, geographical isolation, economic precarity, and language barriers collectively inhibit effective healthcare utilisation. The Malaysian legal system's rigid citizenship criteria and lack of differentiation between stateless persons and undocumented migrants further restrict access to subsidised healthcare. The consequences include low immunisation coverage, delayed treatment, and poor health outcomes, which pose broader public health risks. This review highlights the necessity for targeted policy reforms and culturally sensitive health interventions, including mobile clinics, community health worker training, and legislative updates that recognise the unique needs of stateless maritime groups. Enhancing healthcare access for sea nomads is crucial to ensuring health equity and safeguarding public health in the coastal and borderland regions of Sabah.

In low- and middle-income countries (LMICs), suicide is a major problem. Research on the effectiveness of large-scale suicide prevention interventions is limited. To test the effectiveness of an integrated intervention (school-based prevention; reducing access to means of suicide; increased identification and management of suicide risk) in reducing deaths by suicide and suicide attempts; and to evaluate the implementation and effectiveness of sub-interventions. In this pragmatic cluster randomised controlled trial, 124 villages from Mehsana, India, were randomly assigned to either intervention or control arm. The intervention comprised school-based awareness intervention, community pesticide storage and training of community health workers (CHWs) to recognise, support, refer and follow up people at risk. Intention-to-treat analysis using mixed-effects Poisson regression tested the primary outcome (suicide attempts plus deaths by suicide), and multilevel linear models assessed sub-interventions. The primary outcome was captured through a novel suicide surveillance system. There was no statistically significant difference in the primary outcome between the intervention (54 of 62 consenting villages) and control (62 villages) arms. Separately, the intervention arm showed a 43% reduction in risk of death by suicide at 12 months (suicide rate 30.7 versus 43.6 per 100 000 person-years in intervention versus control arm; incidence rate ratio 0.57, 95% CI: 0.32-1.02, adjusting for baseline and clustering). Most students (≥90%, n = 2330/2560) from 47 schools received the intervention and had lower depression and suicidal ideation than controls at month 3. Nearly all villages (52/54, 96.2%) provided pesticide lockers (n = 8370 households, 88.83% uptake). Compared with controls, CHWs in the intervention arm had significantly higher knowledge, confidence and skills, and identified 108 at-risk individuals. The intervention increased identification without significantly reducing suicide attempts, but reduced suicide deaths. This trial, involving 116 villages and a multicomponent intervention implemented at scale, advances suicide prevention and complex intervention research, especially in LMICs.

Introduction: Our case study was conducted across healthcare facilities in Kilifi and Nairobi, where perinatal adolescents were screened for depression.Objective: The relationship of environmental monitoring in addressing mental health needs of vulnerable perinatal adolescent populations was explored.Methods: We installed outdoor air quality sensors at two facilities in Nairobi—Kangemi and Kariobangi North health centers—and two in Kilifi—Mtwapa and Vipingo health centers—and installed sensors in two households of two perinatal adolescents. Community health workers monitored air quality and noise levels data, collecting experiential data on stress and mood from perinatal adolescents.Findings: Air quality monitoring revealed site-specific variations in PM2.5 concentrations. Kariobangi Health Center recorded the highest mean concentration of 29.45 µg/m³, exceeding the WHO 2021 annual guideline of 5 µg/m³ indicating substantially degraded air quality. Kangemi Health Center was next (21.27 µg/m³), followed by Mtwapa (15.34 µg/m³) and Vipingo (12.52 µg/m³). Noise monitoring revealed consistently elevated exposure in healthcare settings. At Kangemi Health Center, mean noise levels reached 52.2 dB (median: 53.5 dB), surpassing the WHO guideline for hospital settings (<35–40 dB). Household-level air quality monitoring highlighted significant operational challenges: sensor deployment constraints, difficulties in ensuring continuous temporal coverage, and substantial intra-day variability—underscoring the need for improved monitoring design and calibration strategies.Conclusions: We tested air and noise monitoring deployment as a lever for strengthening the health system and a strategy for improved patient care and mental well-being. We trained community health workers and youth leaders in a task-shifting model to collect environmental health data. Our approach sought to ease the deployment of environmental monitoring in a sustainable data collection process. However, both mitigation, targeting reduction in sources of pollution, and adaptation efforts focused on coping with the effects of air and noise pollution on vulnerable populations within primary care need concerted efforts.

Malaria remains a significant public health challenge in the Democratic Republic of Congo (DR Congo), particularly among pregnant women and children under five, who bear the highest burden of disease and mortality. Despite efforts to scale up control programs, the country faces numerous challenges, including limited healthcare access, inadequate funding, insecticide resistance, and gaps in surveillance. Vector control efforts are constrained by minimal government involvement and heavy reliance on international donors. Recent innovations, such as genomic surveillance, rapid diagnostic tests (RDTs), and mobile health (mHealth) solutions, offer new avenues for improving diagnosis, treatment, and data collection. Integrated approaches, such as incorporating malaria prevention into routine maternal and child healthcare, expanding access to vaccines like RTS,S and R21, and improving the distribution of long-lasting insecticidal nets (LLINs), are vital for sustaining control efforts. Community engagement and behavior change strategies are crucial to increasing uptake of preventive measures. Furthermore, climate change necessitates adaptable interventions to address shifting transmission patterns. Strengthening surveillance, training community health workers, and fostering public-private-philanthropic partnerships will enhance capacity for malaria control. Sustainable financing, policy reinforcement, and innovative tools are essential to prevent resurgence and protect vulnerable populations, ensuring progress toward malaria elimination in DR Congo. This review uniquely aims to address and consolidate evidence on pregnant women and young children in the DR Congo context, highlighting innovations and donor-dependence risks.”

ObjectivesThis study assessed the level of knowledge of community health workers (CHWs) regarding water, hygiene, and sanitation (WASH) in the Comè-Bopa-Grand Popo-Houéyogbé health zone in Benin.MethodsA cross-sectional survey was conducted among 160 CHWs selected randomly. Data were collected using a structured questionnaire and analyzed with SPSS 21.0. Logistic regression was used to identify factors associated with CHW knowledge.ResultsMost CHWs (68.8%) had insufficient knowledge of their roles in WASH. Factors significantly associated with good knowledge included Mina ethnicity (OR = 0.3; 95% CI: 0.1–0.9), being married (OR = 10.0; 95% CI: 1.3–77.7), training on activity packages (OR = 3.3; 95% CI: 1.7–10.0), supervision by a qualified agent (OR = 10.2; 95% CI: 2.5–40.6), and participation in group follow-up sessions (OR = 10.0; 95% CI: 5.0–48.9). Multivariate analysis showed that attending at least two group sessions greatly increased the likelihood of good knowledge (OR = 23.9; 95% CI: 5.3–107.7).ConclusionStrengthening CHW training, regular follow-up, and incentives is essential to improve WASH-related knowledge and public health impact.

Purpose: Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to care in low-income settings. Preset hearing aids, which offer user-selectable pre-developed amplification programs, may support such models, but little is known about their real-world use and alignment with clinical recommendations. Method: This longitudinal study formed part of a feasibility project implementing the World Health Organization’s (WHO’s) hearing aid service delivery approach in three low-income South African communities. Adults (≥18 years) with confirmed moderate-to-severe bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs. Participant-driven selections were recorded at four distinct time points: fitting and follow-ups at 2 weeks, 2 months, and 6 months post-fitting. Results: In total, 36 participants (mean age = 76 years, SD = 8.9, range 50–96) were fitted with devices. Although over half (right: 52.8%, left: 58.3%) presented with high-frequency loss, only 34% initially selected the corresponding program. Most participants (80.6%, n = 29) changed their selections at least once over the six months. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. Conclusions: CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings. However, frequent changes and divergence from clinically recommended programs suggest reliance on user-driven trial-and-error adjustments rather than audiometric fit, which may limit long-term benefit. Ongoing, person-centred guidance is needed for the effective use of preset hearing aids.

Background: Primary care is essential to achieving universal healthcare coverage. Task shifting and task sharing are strategies to consider for enhancing access to rehabilitation in primary care. Aim: This study synthesises evidence on task shifting and task sharing rehabilitation strategies in primary care. Setting: The study involves primary care settings worldwide. Method: Peer-reviewed intervention and observational studies on task shifting and task sharing in primary care rehabilitation were searched across five databases. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and Arksey and O’Malley framework, data were extracted and synthesised on training characteristics, health outcomes, and implementation factors to inform future research, policy, and practice. Results: Eleven studies across five countries were included. Community health workers were trained to deliver rehabilitation across various pathologies in primary care. Training of community health workers varied, yet all studies reported positive outcomes. Themes included training methods and the potential for digital tools to enhance delivery and access to rehabilitation. Conclusion: Task shifting and task sharing are promising for strengthening rehabilitation access in primary care. Despite variations in training and delivery, outcomes suggest feasibility in low- and middle-income countries (LMICs). Future research should prioritise standardising a framework for community health worker training. Contribution: This review highlights how task shifting and task sharing can enhance access to rehabilitation in primary care, especially in resource-limited settings. It identifies key implementation factors offering valuable insights for policymakers, practitioners and researchers aiming to strengthen rehabilitation services through workforce innovation and community-based strategies.

Mobile medical camps in rural Khyber Pakhtunkhwa address critical gaps in primary care and advance health equity by bringing free consultations, basic laboratory screenings, immunizations and health education directly to underserved villages. Drawing on firsthand volunteering experiences and regional data, this work highlights how camps organized by local NGOs and medical trainees overcome the prohibitive costs and geographic barriers that leave families traveling hours for simple care. A 2024 study in KP reported that primary health needs “were not met” largely because of cost and outreach deficits, while a Karachi survey of student volunteers found that 77 % improved their understanding of community health, 85 % gained confidence in outpatient care and 94 % developed communication and empathy skills, with nearly half influenced toward primary care careers. In flood‑affected Sindh, outreach teams served more than 16 000 attendees—offering check‑ups, essential immunizations and even psychological first aid—partnering with religious leaders and youth mobilizers to amplify prevention messages. When aligned with district health departments, camps not only treat acute illness but also seed longer‑term improvements by training community health workers, strengthening referral paths and informing policymakers about chronic disease burdens such as unmanaged hypertension and diabetes. Furthermore, medical students return with a deepened commitment to rural practice and policy advocacy, reinforcing the health system from within. While short‑term missions alone cannot resolve poverty or infrastructure gaps, ethically designed camps that emphasize capacity‑building, continuity of care and community partnership can spark sustainable change—rekindling trust in health services and catalyzing policy shifts toward equitable access for all.

Heart disease (HD) and stroke risk can be reduced with adequate cardiovascular disease (CVD) disease prevention as outlined in the American Heart Association's Life's Essential 8 guidelines for modifiable health behaviors. This scoping review examines the roles of community health workers (CHWs) in CVD prevention trials across the United States. In the 24 clinical trials identified, our review emphasizes the effectiveness of CHWs in improving health behaviors and outcomes, particularly for underserved populations with limited access to health care. CHWs were actively engaged in implementing interventions, providing culturally sensitive education, offering health coaching, and supporting lifestyle modifications, such as increased physical activity and medication compliance. Notably, while most studies focused on HD, only three specifically targeted secondary stroke prevention. Beyond their role of delivering behavioral interventions, CHWs supported research efforts by collecting data and maintaining participant involvement. However, their integration into academic teams was inconsistent in terms of scope of practice and level of interprofessional engagement. Furthermore, CHW research contributions were rarely recognized, with a handful acknowledged in publications. Training for CHWs generally included disease-specific knowledge and communication skills. CHW training programs varied considerably in their scope and standards, with unclear role definitions and insufficient collaboration with academic institutions. To enhance CHW-led preventive health care, developing standardized training frameworks, defining CHW responsibilities in clinical and research collaborations and building sustainable community–academic partnerships are suggested. These actions could significantly increase CHWs' role in reducing CVD disparities, thereby promoting more equitable health care across the United States.

Abstract Issue Over 52% of the global population lack access to essential health services. This is disproportionately prevalent in low- and middle-income countries (LMICs) where underserved rural populations face geographical isolation, poor infrastructure, low &amp; consistent incomes, and a shortage of healthcare manpower. To address this, reach52 utilises two interdependent approaches: (1) conducting public health campaigns (PHCs) supported by empowered community health workers (CHWs), in collaboration with local partners, and using an eHealth platform to execute and monitor outcomes, and (2) offers high-quality, low-cost generic medicine - bridging drug access gaps left by profit-driven producers. Description of the problem Globally, more than 52% of the population lacks access to essential health services, and over 2 billion do not have access to essential medicines. In India, reputable studies have reported that there is a USD$13.2 billion financial shortfall to achieve universal health coverage (UHC) - there is a need for financially sustainable solutions to improve health equity and outcomes. In 2024, reach52 operated across 12 states in India where it ran PHCs, trained CHWs, and distributed up to 52 generic medicines through over 269 distributors to over 30,000 pharmacy and physician sites across the country. Reach52 also reinvested 100% of its surplus revenue back into its business to run PHCs and maximise long-term societal impact. Results In 2024, funded through its sustainable social business model and in collaboration with local partners, reach52 trained over 120 CHWs, facilitated over 100,000 health education, screening, and clinic events with local partners, reaching over 4.9 million residents in India. Reach52 also provided affordable medicines to over 3 million rural residents. Reach52 plans to further scale this social business model through partnerships and contracting of in-country implementors, with a focus on expanding across 25 countries in Africa in 2025. Key messages • Reach52 presents a sustainable model for achieving universal health coverage. • Training community health workers instead of directly providing services empowers communities to improve their health.

Multidrug-resistant tuberculosis household contact screening and management by community healthcare workers in Mongolia: a prospective implementation study

IntroductionAntimicrobial resistance (AMR) poses a global health threat, especially in low-income and middle-income countries. Community health workers (CHWs) are key actors in infection management and health promotion; however, their involvement in antimicrobial stewardship (AMS) remains unclear. This study aims to assess CHWs’ roles in AMS, examine their training and support, and evaluate outcomes regarding antibiotic use and resistance.MethodsA scoping review was conducted to explore the roles, education, training and antimicrobial-related outcomes of CHWs. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, with the protocol registered in Open Science Framework. Databases including PubMed, EMBASE and CINAHL were searched for studies published in English and Spanish. A narrative synthesis was applied to the identified articles, with the Integrated Quality Criteria for the Review of Multiple Study Designs and Quality Assessment Tool for Studies with Diverse Designs tools employed to assess the risk of bias.ResultsEight studies were identified, conducted in Uganda, Tanzania, Zambia, Pakistan, Bangladesh and Kenya. CHWs were involved in various AMS activities, such as infection prevention, detection and treatment of conditions such as pneumonia and gastrointestinal infections. CHWs contributed to health education, antibiotic prescription (when authorised) and improved adherence to guidelines. Positive outcomes included reduced inappropriate antibiotic use and increased community awareness of AMR. However, the effectiveness of these interventions varied depending on the local context and resources.ConclusionsCHWs play an important role in promoting responsible antibiotic use and addressing AMR, particularly in underserved settings. Strengthening their training, expanding selected roles and responsibilities and improving support mechanisms should be considered to enhance their potential contribution to AMS programmes. Further research is needed to optimise CHW interventions and evaluate their long-term impact.

Chad, one of the poorest Sub-Saharan Central African countries, has one of the worst global diarrhea burdens. Project 21 seeks to enhance community health in the rural town of Béré, Chad but it is lacking. The study aims to determine diarrhea outcomes and associated factors, such as drinking water, malaria, sanitation and hygiene resources and practices, in Béré. A survey questionnaire was administered by trained community health workers using a random sampling method. The respondents (n = 484) are predominantly Nangtchéré (87%) evangelical (63%) males (88%) aged between 40–59 years old (43%) with secondary school education level (37%) or 8 years of school on average, from nuclear families (78%) with seven members on average, and of medium housing standard (56%). Drinking water treatment, transport and storage (p < 0.001), malaria related factors (p < 0.001), sanitation and hygiene practices (p < 0.001), children diarrhea experience, and treatment (p < 0.001) are predictors of diarrhea outcomes in adults. Also, factors related to drinking water transport, treatment and storage (p < 0.001), malaria (p < 0.001), health advice source (p < 0.001), sanitation and hygiene (p < 0.001), adult diarrhea experiences, and treatment (p < 0.001) are predictors of children diarrhea outcomes. Future interventions targeting the above factors are warranted.

As populations age globally, ensuring equitable healthcare access and social support for older adults in underserved urban areas has become increasingly critical. Elderly residents in low-income districts face challenges, including poor living conditions, social isolation, and healthcare access barriers. Community health workers (CHWs) are vital in bridging these gaps, yet their effectiveness is often Limited by resources and training. This qualitative study explores the healthcare and social needs of elderly residents receiving community services, identifies gaps in support systems, and examines the challenges faced by CHWs in delivering care in an underserved urban district. The study took place in Sham Shui Po, a district in Hong Kong with a high concentration of economically disadvantaged elderly residents. Data were collected through 17 semi-structured interviews with older residents and non-governmental organization (NGO) staff, alongside three focus group discussions with CHWs, and were analyzed using thematic analysis. The results showed that senior residents faced poor living conditions, chronic illnesses, and mobility issues, exacerbated by financial constraints and limited healthcare access. Long wait times, transportation challenges, and language barriers hindered medical service use. Many struggled with digital healthcare tools, limiting their ability to manage health independently. CHWs provided vital support but encountered physical strain, inadequate training, and logistical difficulties, highlighting the need for structured training and better resources. Addressing elderly care challenges requires integrated healthcare models, expanded financial and digital literacy programs, and enhanced CHW training and support. Strengthening these areas can improve health outcomes and well-being for aging populations in low-income urban settings.

BACKGROUNDTB continues to pose significant public health challenges in high-burden regions such as Kano State, Nigeria, where private health sector engagement in TB control is notably lacking. The Social Franchising for TB Contact Investigation (SOFT) model was introduced to leverage private healthcare to increase the reach and efficacy of TB control efforts.METHODSThis nine-month project supported mapping health facilities, training of community health workers and systematic TB contact screening. The SOFT model aimed to enhance TB control by integrating private healthcare facilities and community-based organisations to improve TB yield, contact investigation and uptake of TB Preventive Therapy (TPT).RESULTSThe project showed a consistent increase in TB case detection, with a significant rise in index TB cases identified and their contacts screened each quarter. There was also a marked increase in the number of household contacts screened and initiated on TPT, demonstrating the model’s effectiveness in enhancing TB control efforts.CONCLUSIONThe integration of social franchising with community and private healthcare engagement presents a scalable and innovative approach to improving TB control in high-burden settings. This model contributes significantly to global TB elimination efforts by improving detection rates and TPT uptake.

BackgroundIn light of the public health crisis of dementia, community health workers (CHWs) have increasingly received national attention as a public health workforce that can support individuals, families, and communities in preventing, recognizing, and living with dementia. With training, CHWs have high potential for making a positive impact on healthy aging and living with dementia. Recognizing the need for a CHW-specific training, the Oklahoma Dementia Care Network (OkDCN) developed the Dementia Training for Community Health Workers. This paper examines the training program’s pedagogical framework and comprehensive evaluation processes, tools, and outcomes.MethodsThis training was developed as a train-the-trainer model combining didactic instruction with adult learning strategies. The training’s content resulted from combining knowledge about CHWs in Oklahoma, National C3 Council recommendations on the CHW scope of work, and evidence-based dementia care strategies. The evaluation design measures effectiveness focused on the first three levels of the Kirkpatrick Model, i.e., CHW training feedback, knowledge and skill acquisition, and application of the training knowledge and resources. The OkDCN collaborated with CHWs to develop and implement the training.ResultsBetween June 2020 and March 2024, we conducted 15 trainings with a total of 307 trainees. Data collected on pre/post knowledge, self-efficacy, and post-training feedback were analyzed as a subsample of the total number of trainees. Among this subsample (50%; n = 154) both knowledge and some of the self-efficacy items showed statistically significant improvements. Overall, trainees were satisfied with the training in terms of content, format, and delivery. A follow-up survey showed that trainees appreciated the practical value of the training for their jobs and used the information in their day-to-day work, but did not yet conduct dementia trainings in their communities.ConclusionAs CHWs are tasked with alleviating the public health crisis of dementia, they necessitate geriatric-focused education that is evidence based, workforce-appropriate, and adaptable to diverse communities. Designed specifically for CHWs as a peer-implemented train-the-trainer model, this innovative training contributes to both workforce development and health equity. CHWs who apply or pass on their knowledge can make positive impacts on their communities’ healthy aging.

Pragmatic strategies for improving prevention, diagnosis, and treatment of epilepsy in low- and middle-income countries.

Chad, a Sub-Saharan country, has some of the worst child mortality and health indicators. A lack of recent and accurate health records in Béré, rural Chad, due to decades of strife compromises the development of relevant health interventions by Project 21, a community health program. This study investigates child mortality, weight gain ability, and related factors in 0–2-year-olds through a cross-sectional study completed by trained community health workers using a survey questionnaire. Most household heads are Nangtchéré Christian males with secondary-level education. Male infants have the highest mortality rate. Infant mortality is predicted by non-exclusive breastfeeding started within 6 days after birth and by the number of household children who experienced and received treatment for meningitis. Toddlers’ mortality is predicted by the number of household adults who experienced and received treatment for meningitis and the number of household adults and children who were vaccinated. The odds of children having no difficulty gaining weight vary with their gender, age, the food or liquid given to them, the source of breastfeeding advice, handwashing and vaccination practices, and experiences with infectious diseases and their treatments. These findings provide targets for future health interventions towards achieving SDG3 in Sub-Saharan Africa.

In San Lucas Tolimán (SLT), Guatemala, a rural municipality with a large Indigenous population, women seeking cervical cancer screening face many barriers. We describe the process from design to implementation of a culturally appropriate and accessible cervical cancer screening and treatment pilot program for women aged 30-49 years. After conducting a community needs assessment, we trained community health workers (CHWs) on basic cervical cancer pathophysiology and human papillomavirus (HPV) self-swab kit use. CHWs provided educational seminars and enrolled interested, eligible women in a mobile health application. Women collected samples at home and returned completed kits to CHWs, who sent the kits to a partner lab. Women who were positive for HPV received follow-up care at the local hospital, where physicians had received training in visual inspection with acetic acid (VIA) with same-day cryotherapy or thermocoagulation. Women with advanced lesions received access to care from gynecologists free of cost. Between February and November 2023, of the 230 women eligible to participate in the program, 132 completed HPV self-swabs and received results, and 34 received positive HPV tests (25.76% prevalence). Sixty-seven women had VIA exams as their first screening. Women who received VIA exams had an overall positivity rate of 24.47% (23/94). Twenty-three women received treatment: cryotherapy (n=8), thermocoagulation (n=7), or loop electrosurgical excision procedure (n=8). SLT had higher HPV-positivity rates than nearby Escuintla (21.6%; P=.29) and significantly higher than Santiago Atitlán (17.4% HPV+; P=.02). Our screening program found significantly higher HPV-positivity rates in SLT than in previous Guatemalan studies. Our research reinforces that adequately treating cervical cancer in Guatemala requires accompaniment during care and economic support to make care affordable or free. Based on our pilot program, organizations worldwide can further invest in culturally sensitive cervical cancer screening and treatment.

Community Health Workers (CHWs) play a crucial role in malaria control efforts, yet their contributions to large-scale field trials remain understudied. This research examined the management of CHWs recruited to support a phase III trial of Attractive Targeted Sugar Baits (ATSBs) in Western Zambia. The study aimed to understand the extent to which CHW involvement in the trial aligned with best practices and challenges faced by CHWs implementing health promotion activities. A literature review, review of Zambia Ministry of Health Guidelines, and review of WHO guidelines was conducted to identify best practices and common challenges for CHWs contributing to the delivery of malaria interventions. Subsequently ATSB trial documents were reviewed to compare CHW involvement and CHW challenges experienced during the ATSB trial from 2021 to 2023. A comparative analysis was utilized to assess the involvement of CHWs in the ATSB trial against literature review findings, specific to CHW recruitment, training, supervision, incentivization, and community support. Five best practices for CHW delivery of interventions were identified: participatory and gender equitable recruitment and selection; comprehensive training; incentivization for enhanced motivation and performance; high quality supportive supervision; and fostering community support. Five common challenges for involving CHWs in programme delivery were identified: inadequate and poor-quality supervision of CHWs; low compensation and motivation; logistical constraints; workload and multiplicity of roles, and community challenges. The analysis found that ATSB trial practices largely aligned with literature best practices and established guidelines, particularly in training and incentive structures. However, challenges were identified in achieving gender balance (32% female CHWs in year 2), community involvement in CHW selection, and coordination between CHWs and research team members. CHW involvement was a key factor towards successfully implementing the trial protocol. Experiences with CHWs involvement in the ATSB trial in Zambia suggest that some facets of field research readily facilitate adherence to best practices for CHW recruitment and management. Additionally, field research that is adequately funded and characterized by rigorous implementation may avoid some of the common challenges faced by CHWs implementing health promotion activities. Nonetheless, some CHW cadre challenges appear universal to programmatic and research contexts, including an imbalance in gender representation favouring male participation in CHW opportunities. More documentation of research experiences may be needed to understand CHW involvement and experiences in field research outside of randomized controlled trials.