Draper Catherine E, Soepnel Larske, Mabetha Khuthala, Motlhatlhedi Molebogeng, Nkosi Nokuthula, Lye Stephen J, Norris Shane A
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto and Departments of Obstetrics and Gynecology, Physiology and Medicine, University of Toronto, Toronto, ON, Canada.
BMC Health Serv Res. 2024 Dec 23;24(1):1641. doi: 10.1186/s12913-024-12127-0.
As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali health promotion intervention is being implemented by community health workers (CHW's) with young women in urban Soweto. The perspectives of these CHW's have not been fully explored.
A qualitative study was conducted to describe CHW's perspectives and experiences of delivering the Bukhali intervention. Three focus groups were conducted with the 13 CHWs employed at the time of the study, and a thematic approach was taken to data analysis.
Themes identified included: contextual realities for participants and CHWs, building relationships with participants, workload, emotional toll, and learning and development. Since they are recruited from Soweto, CHWs experienced similar contextual challenges to participants, and have to manage multiple roles, including health promotion and education, referral and support within the health system, counselling (although out of their scope of work), and data recording. The findings indicate the critical role CHWs play in building relationships with participants, especially establishing trust. Many CHWs spoke about going beyond what was expected in their role, which sometimes involved taking participants to medical facilities, and sharing resources with their participants. They spoke about the emotional toll of managing these relationships, their workload, and particularly the need for resilience and boundaries. CHWs experienced learning and development in their role as positive.
These findings provide a voice for these CHWs, but they also offer important learning of the implementation of the Bukhali intervention within the context of Soweto, as well as, future potential scale-up of CHW-delivered interventions in South Africa and other low- and middle-income countries.
作为南非“健康生活轨迹倡议”的一部分，布卡利健康促进干预措施正由社区卫生工作者（CHW）在索韦托市区与年轻女性一起实施。这些社区卫生工作者的观点尚未得到充分探讨。
开展了一项定性研究，以描述社区卫生工作者对实施布卡利干预措施的观点和经验。对研究期间受雇的13名社区卫生工作者进行了三个焦点小组访谈，并采用主题分析法进行数据分析。
确定的主题包括：参与者和社区卫生工作者的背景现实、与参与者建立关系、工作量、情感负担以及学习与发展。由于社区卫生工作者是从索韦托招募的，他们面临着与参与者类似的背景挑战，并且必须承担多种角色，包括健康促进与教育、卫生系统内的转诊与支持、咨询（尽管超出其工作范围）以及数据记录。研究结果表明社区卫生工作者在与参与者建立关系，尤其是建立信任方面发挥着关键作用。许多社区卫生工作者谈到超越了其角色预期，有时包括带参与者去医疗设施，并与参与者分享资源。他们谈到了管理这些关系、工作量所带来的情感负担，特别是对适应力和界限的需求。社区卫生工作者将其角色中的学习与发展视为积极的方面。
这些研究结果为这些社区卫生工作者提供了发声机会，但也为在索韦托背景下实施布卡利干预措施，以及未来在南非和其他低收入和中等收入国家扩大由社区卫生工作者提供的干预措施提供了重要借鉴。
