肯尼亚西部社区对社区卫生工作者(CHWs)及其在艾滋病毒、结核病和高血压管理中所扮演角色的认知

Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.

作者信息

Rachlis Beth, Naanyu Violet, Wachira Juddy, Genberg Becky, Koech Beatrice, Kamene Regina, Akinyi Jackie, Braitstein Paula

机构信息

Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.

University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.

出版信息

PLoS One. 2016 Feb 22;11(2):e0149412. doi: 10.1371/journal.pone.0149412. eCollection 2016.

Abstract

Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.

摘要

鉴于医疗保健提供者短缺,以及患有传染病和非传染病的人数不断增加,社区卫生工作者(CHW)越来越多地被纳入医疗保健项目。作为肯尼亚西部“提供医疗保健学术模式项目”(AMPATH)的一部分,我们试图探讨社区对社区卫生工作者的看法,包括对他们在慢性病管理中所起作用的看法。在2012年7月至2013年8月期间进行了深入访谈和焦点小组讨论。研究参与者是从AMPATH的三个地点有目的地抽取的:Chulaimbo、Teso和Turbo,包括接受艾滋病病毒、结核病(TB)和高血压(HTN)护理的AMPATH项目患者,以及感染艾滋病病毒儿童的照顾者、社区领袖和医护人员。参与者被要求描述他们对AMPATH社区卫生工作者的看法,包括确定他们在参与艾滋病病毒、结核病和高血压等慢性病护理中所扮演的各种角色。对数据进行编码并确定了各种主题。我们使用卫生服务利用的安徒生-纽曼框架,并将社区卫生工作者视为一种潜在的促进资源,对产生的概念和主题进行了组织。共有207名参与者,包括110名艾滋病病毒感染者(n = 50)、结核病患者(n = 39)或高血压患者(n = 21);24名照顾者;10名社区领袖;以及34名医护人员参与。参与者确定了社区卫生工作者的几个角色,包括促进初级保健、鼓励检测、提供教育和促进参与护理。虽然发现了社区卫生工作者的各种促进因素,但也提出了社区卫生工作者护理的几个障碍,包括培训和保密问题。还描述了有助于社区卫生工作者改善服务的建议资源。我们的研究结果表明,社区卫生工作者可以通过增强社区成员的知识和支持来发挥催化剂和榜样的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4618/4764025/468a91dc9c67/pone.0149412.g001.jpg

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