Great Lakes University of Kisumu, P O Box 2224, Kisumu, 40100, Kenya.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America.
Hum Resour Health. 2018 Oct 4;16(1):53. doi: 10.1186/s12960-018-0318-4.
Community health workers play an important role in health service delivery and are increasingly involved in behaviour change interventions, including for hygiene-related behaviour change. However, their role and capacity to deliver behaviour change interventions, particularly in high-density urban settlements, remain under-researched. This study examines the behaviour change-related activities of community health volunteers (CHVs)-community health workers affiliated with the Kenyan Ministry of Health-in a peri-urban settlement in Kenya, in order to assess their capabilities, opportunities to work effectively, and sources of motivation.
This mixed-methods study included a census of 16 CHVs who work in the study area. All CHVs participated in structured observations of their daily duties, structured questionnaires, in-depth interviews, and two focus group discussions. Structured data were analysed descriptively. Thematic content analysis was followed for qualitative data. Results were synthesized and interpreted using the capability, opportunity, motivation for behaviour change framework, COM-B.
In addition to their responsibilities with the Ministry of Health, CHVs partnered with a range of non-governmental organizations engaged in health and development programming, often receiving small stipends from these organizations. CHVs reported employing a limited number of behaviour change techniques when interacting with community members at the household level. Capability: While supervision and support from the MOH was robust, CHV training was inconsistent and inadequate with regard to behaviour change and CHVs often lacked material resources necessary for their work. Opportunity: CHVs spent very little time with the households in their allocated catchment area. The number of households contacted per day was insufficient to reach all assigned households within a given month as required and the brief time spent with households limited the quality of engagement.
Lack of compensation was noted as a demotivating factor for CHVs. This was compounded by the challenging social environment and CHVs' low motivation to encourage behaviour change in local communities.
In a complex urban environment, CHVs faced challenges that limited their capacity to be involved in behaviour change interventions. More resources, better coordination, and additional training in modern behaviour change approaches are needed to ensure their optimal performance in implementing health programmes.
社区卫生工作者在卫生服务提供中发挥着重要作用，并且越来越多地参与行为改变干预，包括与卫生相关的行为改变。然而，他们在提供行为改变干预方面的角色和能力，特别是在高密度城市住区，仍然研究不足。本研究检查了肯尼亚卫生部下属社区卫生志愿者（CHV）——社区卫生工作者在肯尼亚一个城市周边住区的与行为改变相关的活动，以评估他们的能力、有效工作的机会和激励来源。
这项混合方法研究包括对在研究区域工作的 16 名 CHV 进行普查。所有 CHV 都参与了他们日常职责的结构化观察、结构化问卷、深入访谈和两次焦点小组讨论。结构化数据进行了描述性分析。定性数据采用主题内容分析。使用行为改变的能力、机会、动机框架（COM-B）对结果进行综合和解释。
除了卫生部的职责外，CHV 还与许多参与卫生和发展规划的非政府组织合作，他们经常从这些组织获得少量津贴。CHV 报告在与社区成员进行家庭层面互动时，使用了有限数量的行为改变技术。能力：尽管卫生部的监督和支持很有力，但 CHV 培训在行为改变方面不一致且不足，而且 CHV 经常缺乏开展工作所需的物质资源。机会：CHV 花在其分配的集水区中的家庭上的时间很少。每天联系的家庭数量不足以在规定的一个月内接触到所有指定的家庭，而且与家庭相处的短暂时间限制了互动的质量。
缺乏补偿被认为是 CHV 的一个激励因素。这因具有挑战性的社会环境和 CHV 对在当地社区鼓励行为改变的低动机而变得更加复杂。
在复杂的城市环境中，CHV 面临着限制其参与行为改变干预能力的挑战。需要更多的资源、更好的协调和现代行为改变方法的额外培训，以确保他们在实施卫生方案方面的最佳表现。
