Community Health Department, Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi.
Glob Health Action. 2022 Dec 31;15(1):2090123. doi: 10.1080/16549716.2022.2090123.
Community health workers (CHWs) play a vital role in facilitating social connectedness, building trust, decrease stigma, and link communities to essential healthcare and social support services. More studies are needed to understand the factors facilitating these interactions among CHWs, clients, and community members.
This study examined the CHW role and relationships between CHWs, communities, and health facilities that promote trust, positive relationships, and social connectedness.
In 2016, the CHW program in Neno District, Malawi, was transitioned to a household-level assignment of CHWs to provide screening, linkage to care, and psychosocial and chronic disease support from a disease-based program. We employed an exploratory qualitative study with thematic analysis linked to Fredrickson's broaden-and-build theory of positive emotions through focus group discussions (FGDs) and in-depth interviews (IDIs) to understand the impact of the household assignment. We purposively sampled community stakeholders, CHWs, health service providers, and clients (total N = 180) from October 2018 through March 2020. All interviews were audiotaped, transcribed verbatim, translated, coded, and analyzed.
Participants reported decreased stigma and discrimination with increased trust and confidence in CHWs with household-level assignment. Positive relationships between CHWs in their households, community members, and health facility staff fostered health knowledge, individual agency, and personal resources for the community members to access health services. Community members' personal resources of increased health knowledge, trust, gratitude, and social support improved social connectedness and subjective wellbeing. Areas to improve positive relationships include CHWs maintaining confidentiality and caring for pregnant women.
Our study findings demonstrate that by building solid relationships as a community chosen, well informed, and household-level workforce, CHWs can develop positive relationships with communities and the health-care facility staff through building knowledge, trust, gratitude, and hope. Further work is needed in maintaining CHW confidentiality and new ways to approach culturally sensitive health areas.
社区卫生工作者（CHW）在促进社会联系、建立信任、减少污名化以及将社区与基本医疗和社会支持服务联系起来方面发挥着至关重要的作用。需要更多的研究来了解促进 CHW、客户和社区成员之间这些互动的因素。
本研究考察了 CHW 角色以及促进信任、积极关系和社会联系的 CHW、社区和卫生机构之间的关系。
2016 年，马拉维 Neno 区的 CHW 计划过渡到 CHW 以家庭为单位分配的模式，为居民提供筛查、与护理机构的联系以及心理社会和慢性疾病支持，该模式是从以疾病为基础的项目转变而来。我们采用了一种探索性的定性研究，主题分析与弗雷德里克森的积极情绪拓宽-构建理论相关联，通过焦点小组讨论（FGD）和深入访谈（IDI）了解家庭分配的影响。我们从 2018 年 10 月至 2020 年 3 月，有目的地从社区利益相关者、CHW、卫生服务提供者和客户中（共 180 人）进行了抽样。所有访谈均进行了录音、逐字记录、翻译、编码和分析。
参与者报告说，与家庭分配的 CHW 相比，他们的信任度和信心增加，污名化和歧视减少。CHW 在家庭、社区成员和卫生机构工作人员之间建立了积极的关系，促进了社区成员的健康知识、个人能力和个人资源，使他们能够获得卫生服务。社区成员的个人资源，包括增加的健康知识、信任、感激和社会支持，提高了社会联系和主观幸福感。需要改进积极关系的领域包括 CHW 维护保密性和照顾孕妇。
我们的研究结果表明，通过建立牢固的关系，作为社区选择的、信息灵通的、家庭为基础的劳动力，CHW 可以通过建立知识、信任、感激和希望，与社区和卫生保健机构工作人员建立积极的关系。需要进一步努力维护 CHW 的保密性，并探索处理文化敏感健康领域的新方法。
