Dahal Usha, Tamang Rekha Lama, Dræbel Tania Aase, Neupane Dinesh, Koirala Adhikari Sweta, Soti Pabitra Babu, Gyawali Bishal
Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Nepal Development Society, Kaski, Nepal.
PLOS Glob Public Health. 2023 Nov 22;3(11):e0002632. doi: 10.1371/journal.pgph.0002632. eCollection 2023.
The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.
非传染性疾病(NCDs)的全球负担促使社区卫生工作者(CHWs)更多地参与到非传染性疾病的预防和管理中,尤其是在资源匮乏的地区。然而,对于社区卫生工作者在提供居家非传染性疾病管理服务时如何应对复杂社会环境的经历,我们却知之甚少。本研究旨在探索尼泊尔西部一个社区试点项目中女性社区卫生志愿者(FCHVs)的经历,特别是她们在提供基本的2型糖尿病(T2D)服务时所面临的社会挑战。该研究采用定性现象学方法,分别对总共14名和9名女性社区卫生志愿者进行了两次焦点小组讨论和九次深入访谈。运用社会资本理论来理解社会学方面的问题。研究结果揭示了女性社区卫生志愿者在扩大社交网络、建立信任以及促进2型糖尿病干预接受者之间的互惠方面所遇到的挑战。值得注意的是,社会信任是一个重大挑战,与性别和社会经济地位相关的权力动态使其更加复杂。女性社区卫生志愿者通过坚持不懈、自我激励以及利用她们强大的纽带和桥梁社会资本成功克服了这些挑战。她们从社区获得的认可在维持其积极性方面发挥了关键作用。该研究强调了女性社区卫生志愿者强大的社会资本在克服社会障碍方面的重要性,这种社会资本得到可用资源和个人积极性的支持。社区卫生干预必须预见社会资本各个要素所面临的挑战,以确保社区卫生工作者的长期留用和积极性。建立适当的支持系统,解决个人激励因素并加强社会资本至关重要。