缅甸社区卫生工作者在疟疾消除中扩大角色的可接受性、可行性和保真度:一项混合方法研究
Acceptability, feasibility and fidelity of an expanded role for community health workers for malaria elimination in Myanmar: A mixed-method study.
作者信息
Oo Win Han, Khant Kaung Myat, Htwe Ei Phyu, Htike Win, Aye Tun Nilar, Oo May Chan, Thu Kaung Myat, Zaw Aung Khine, Galau Naw Hkawng, O'Flaherty Katherine, Agius Paul A, Fowkes Freya J I
机构信息
Health Security and Pandemic Preparedness Program, Burnet Institute, Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
出版信息
PLOS Glob Public Health. 2025 Aug 13;5(8):e0004986. doi: 10.1371/journal.pgph.0004986. eCollection 2025.
As countries transition to malaria elimination many are considering expanding the role of dedicated malaria community health workers (CHWs) to provide both malaria and limited primary health care services. The acceptability, feasibility and fidelity of an expanded role for CHW are vital factors for the successful implementation and sustainability of this health care model and data are needed to inform policy change.To further inform an expanded CHW model for malaria elimination, a mixed-method study nested in a trial which demonstrated effectiveness was undertaken to determine the acceptability, feasibility and fidelity of an expanded role for CHW in Myanmar. Data were collected as part of the trial including qualitative semi-structured in-depth interview with community leaders (n = 6) and health stakeholders (n = 14), focus group discussions (n = 36), supervision (n = 69) and field observation visits (n = 6) with CHWs. A quantitative cross-sectional survey was administered to community members (n = 643). Qualitative and quantitative data were analysed thematically and descriptively, and then triangulated for rigour. The expanded CHW model was acceptable to different levels of health stakeholders, CHWs and community members (97.4%, 626/643) because it addressed the community demand of health services (93.0%, 598/643) and promoted the roles of the CHWs within the framework of health regulations. Its implementation was also feasible due to the enthusiasm and high fidelity (97.1%, 67/69) of the CHWs as well as reliance of community members on expanded CHW services (98.3%, 632/643). However, aspects of training, supervision, supply chain management, referral mechanisms, and recording and reporting of data could have been improved. The expanded role for CHW model was found to be feasible to implement and acceptable to community members and stakeholders. With further investment and optimisation, wider-scale implementation of the model in malaria elimination settings may contribute to the goals of malaria elimination and effective primary health care in malaria elimination settings.
随着各国向消除疟疾过渡,许多国家正在考虑扩大专门的疟疾社区卫生工作者(CHW)的作用,以便同时提供疟疾和有限的初级卫生保健服务。CHW扩大作用的可接受性、可行性和保真度是这种卫生保健模式成功实施和可持续发展的关键因素,需要数据来为政策变革提供依据。为了进一步为消除疟疾的CHW模式扩展提供信息,在一项已证明有效的试验中进行了一项混合方法研究,以确定CHW在缅甸扩大作用的可接受性、可行性和保真度。作为试验的一部分收集了数据,包括对社区领袖(n = 6)和卫生利益相关者(n = 14)进行定性半结构化深入访谈、焦点小组讨论(n = 36)、对CHW的监督(n = 69)以及实地观察访问(n = 6)。对社区成员(n = 643)进行了定量横断面调查。对定性和定量数据进行了主题分析和描述性分析,然后进行三角验证以确保严谨性。扩大的CHW模式为不同层面的卫生利益相关者、CHW和社区成员所接受(97.4%,626/643),因为它满足了社区对卫生服务的需求(93.0%,598/643),并在卫生法规框架内促进了CHW的作用。由于CHW的热情和高保真度(97.1%,67/69)以及社区成员对扩大的CHW服务的依赖(98.3%,632/643),其实施也是可行的。然而,培训、监督、供应链管理、转诊机制以及数据记录和报告等方面仍有待改进。发现扩大的CHW模式在实施上是可行的,并且为社区成员和利益相关者所接受。通过进一步投资和优化,在消除疟疾环境中更广泛地实施该模式可能有助于实现消除疟疾的目标以及在消除疟疾环境中提供有效的初级卫生保健。
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