Improving the health literacy of Lay Community Health Workers (LCHWs) in Southern Africa to improve the health of women and children
Lead Research Organisation:
University of Warwick
Department Name: Warwick Medical School
Abstract
This research project ultimately aims to improve the health literacy of Lay Community Health Workers (LCHWs) in rural Southern Africa to enable women to make better choices about their own and their children's health.
Lay Community Health Workers (LCHWs) complement primary healthcare clinics by providing health advice and care in family homes in rural Southern Africa. LCHWs provide antenatal and postnatal care, general health advice and also support management of chronic conditions such as HIV. However, their role is currently limited by their basic, insufficient and poor training and a lack of understanding and use of information to promote and maintain good health, known as health literacy. Health Literacy is very poor among rural black Southern African women and therefore, choices that women make about their own and their children's health are often poorly informed. In turn, this contributes to increased pressure on already overburdened primary health services in Southern Africa and poor health outcomes, in particular malnutrition and underweight children. Health Literacy and empowerment are essential to enable women to make informed decisions to improve their own and their children's health, for example relating to contraception and infant feeding and nutrition.
We are targeting rural black Southern African women and their children as health literacy is poor amongst this population. We are working with Sizabantu, a training provider in Southern Africa, to develop, implement and evaluate a training intervention for LCHWs in four communities. In order to develop the training intervention, we first need to identify the facilitators and barriers to change before starting an educational programme. This is because improving health literacy in this population is particularly challenging, since health information may conflict with women's prior beliefs (including stigma and myths) making it less likely to be adapted. Therefore, the training intervention needs to consider more than educational content in order to help LCHWs draw women's beliefs out into the open and provide a safe environment in which women can be equipped with the knowledge and skills to understand and make sense of their options.
Once the training intervention has been developed and evaluated for effectiveness in four communities in South Africa, it will be rolled out to communities in Lesotho and Mozambique. The educational programme will include training for LCHWs on sexual and reproductive health, antenatal health and early childhood health and development. Once LCHWs have taken part in the educational training programme they will then use their newly-acquired knowledge and skills to improve the health literacy of black African women during weekly household visits.
The ultimate outcome of the intervention is for black African women to be able to make the necessary positive decisions to improve their own and their children's health. The type of positive health decisions that are most likely to arise as a result of this study include uptake of (more effective) contraception methods to reduce sexually transmitted diseases and increased breast feeding rates.
Lay Community Health Workers (LCHWs) complement primary healthcare clinics by providing health advice and care in family homes in rural Southern Africa. LCHWs provide antenatal and postnatal care, general health advice and also support management of chronic conditions such as HIV. However, their role is currently limited by their basic, insufficient and poor training and a lack of understanding and use of information to promote and maintain good health, known as health literacy. Health Literacy is very poor among rural black Southern African women and therefore, choices that women make about their own and their children's health are often poorly informed. In turn, this contributes to increased pressure on already overburdened primary health services in Southern Africa and poor health outcomes, in particular malnutrition and underweight children. Health Literacy and empowerment are essential to enable women to make informed decisions to improve their own and their children's health, for example relating to contraception and infant feeding and nutrition.
We are targeting rural black Southern African women and their children as health literacy is poor amongst this population. We are working with Sizabantu, a training provider in Southern Africa, to develop, implement and evaluate a training intervention for LCHWs in four communities. In order to develop the training intervention, we first need to identify the facilitators and barriers to change before starting an educational programme. This is because improving health literacy in this population is particularly challenging, since health information may conflict with women's prior beliefs (including stigma and myths) making it less likely to be adapted. Therefore, the training intervention needs to consider more than educational content in order to help LCHWs draw women's beliefs out into the open and provide a safe environment in which women can be equipped with the knowledge and skills to understand and make sense of their options.
Once the training intervention has been developed and evaluated for effectiveness in four communities in South Africa, it will be rolled out to communities in Lesotho and Mozambique. The educational programme will include training for LCHWs on sexual and reproductive health, antenatal health and early childhood health and development. Once LCHWs have taken part in the educational training programme they will then use their newly-acquired knowledge and skills to improve the health literacy of black African women during weekly household visits.
The ultimate outcome of the intervention is for black African women to be able to make the necessary positive decisions to improve their own and their children's health. The type of positive health decisions that are most likely to arise as a result of this study include uptake of (more effective) contraception methods to reduce sexually transmitted diseases and increased breast feeding rates.
Technical Summary
Lay Community Health Workers (LCHWs) complement primary healthcare clinics by providing health advice and care in family homes in rural Southern Africa. LCHWs support hypertension management and HIV but also provide antenatal and postnatal care and general healthcare advice. Their role is however currently limited by their basic, insufficient and poor standard training, and lack of Health Literacy (HL). HL, defined by the WHO as "the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health", has a positive effect on health outcomes. Working in partnership with Sizabantu, the training provider, the proposed research is based on the development, implementation and evaluation of a "training the trainer" HL intervention for LCHWs. The aims are to: (1) enhance the role and effectiveness of LCHWs, (2) improve women's own HL, (3) empower women to make decisions regarding their own and their children's health and (4) improve women's and their children's health. The early stage study includes the initial development and formative evaluation of the intervention in four communities in South Africa. The objectives of this stage of the project are to: (1) develop the intervention through contemporaneous study of the process of educating and motivating LCHWs, (2) undertake a formative evaluation of intervention using qualitative methods to enable refinement prior to piloting, rollout and evaluation using a cluster randomised stepped wedge design and (3) test quantitative outcome measures and collect quantitative data to calculate sample size requirements for the main study.
Publications
Taylor C
(2017)
Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa.
in BMJ global health
Plowright A
(2018)
Formative evaluation of a training intervention for community health workers in South Africa: A before and after study.
in PloS one
Description | Community Health Worker Training Workshop Curriculum- HIV/AIDS, TB and STIs in South Africa (HAST) |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Description | Health Systems Global Thematic Working Group on Supporting and Strengthening the Role of Community Health Workers in Health Systems Development |
Organisation | Health Systems Global Network |
Country | Unknown |
Sector | Learned Society |
PI Contribution | Richard Lilford is a member of the international Health Systems Global Thematic Working Group on Supporting and Strengthening the Role of Community Health Workers in Health Systems Development |
Collaborator Contribution | The objectives of the thematic working group are to: Raise awareness of the crucial role that community health workers play within the health system Bring together a diverse individuals and networks to share knowledge in a structured and facilitated manner Convene practitioners and decision-makers in order to better understand the real world challenges being faced and encourage the use of the existing and emerging evidence base in policy and practice Promote an institutionalized practice of monitoring interventions and evaluating results by all decision-makers and practitioners Amplify the voices of community health workers and community groups within these dialogues This work includes: supporting dialogue online; arranging events, for example at the Global Symposium on Health Systems; facilitating learning across the group, for example through webinars; supporting research; and publishing and evidence translation into products, which meet the needs of diverse audiences. |
Impact | Community Health Worker research workshop between University of Warwick and Liverpool School of Tropical Medicine |
Start Year | 2016 |
Description | Engagement with the Human Sciences Research Council South Africa |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | Dr Edmore Marinda, Research Director of Monitoring and Evaluation at the Human Sciences Research Council South Africa has formally joined the project steering committee and taken part in two meetings so far. He is providing advice and guidance on engaging with policy makers and practitioners across South Africa. |
Year(s) Of Engagement Activity | 2016,2017 |
Description | How much should Community Health Workers in sub-Saharan Africa be paid? What works Global Summit (London September 2016) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | How much should Community Health Workers in sub-Saharan Africa be paid? Presented at the What Works Global Summit, 26-28 September 2016, London. |
Year(s) Of Engagement Activity | 2016 |
URL | https://www.wwgs2016.org/ |
Description | LCHWs Intervention development workshop |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Study participants or study members |
Results and Impact | 28 Lay Community Health Workers attended a workshop to discuss their role, motivations, issues and obstacles, perspectives on training available, the health system in South Africa, community based care and health. This workshop helped to identify modules for the training intervention. Meetings have also taken place with health practitioners to develop and agree content in KwaZulu Natal and government representatives to discuss the training intervention. |
Year(s) Of Engagement Activity | 2015 |
Description | Presentation at Community Health Worker Symposium 2017, Uganda |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | A presentation on the project delivered by Dr Alexandra Plowright titled "Living on the frontline: Community health work in rural South Africa". There was discussion afterwards regarding the training. |
Year(s) Of Engagement Activity | 2017 |
Description | Presentation at the Symposium on Community Health Workers and their contribution towards the Sustainable Development Goals |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Presentation at the Symposium on Community Health Workers and their contribution towards the Sustainable Development Goals which took place in Uganda from 21st Feb to 23rd Feb 2017 and hosted by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda. The presentation was titled: Living on the frontline: Community health work in rural South Africa which explained the project background, research methods, results and recommendations for practice. |
Year(s) Of Engagement Activity | 2017 |
URL | http://chwsymposium.musph.ac.ug/ |
Description | Site visit to Lepoqong Caregivers and Malealea Clinic in Lesotho |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Dr Alex Plowright (researcher on study) and Prof Gillian Hundt (Co-applicant) visited the Lepoqong Caregivers and Malealea Clinic in Lesotho to present the current pilot training intervention taking place in South Africa and discuss plans for roll out in Lesotho. Lepoqong is an NGO (+-24 CHWs, who each work at community level, some provide additional support to government facilities. Each caregiver has working links with at least 3 other CHWs who operate in the surrounding areas). Malealea Clinic is a government clinic (84 government CHWs, who operate in the rural villages surrounding Malealea, supervised by one clinic manager). They are very keen to be involved in further roll-out if funding is secured. |
Year(s) Of Engagement Activity | 2016 |
Description | The affordability of comprehensive Community Health Worker programmes in sub-Saharan Africa - presentation at the NVTG-symposium: Health of People on the Move, Amsterdam 2016 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation by Dr Celia Taylor on "The affordability of comprehensive Community Health Worker programmes in sub-Saharan Africa" Presented at the NVTG-symposium: Health of People on the Move, 28 October 2016, Amsterdam |
Year(s) Of Engagement Activity | 2016 |
Description | Visit to Salvation Army in Mbabane, Swaziland |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Dr Alex Plowright (researcher on study) and Prof Gillian Hundt (Co-applicant) visited the Salvation Army in Mbabane, Swaziland to present the current pilot training intervention taking place in South Africa and discuss plans for roll out in Swaziland. The Salvation Army already have a funded CHW project for refresher training funded. They are required to identify what topics the CHWs would like to have training on and are very interested in adopting our training intervention in terms of content and in having their nurse counsellors trained as trainers so they could cascade the training. We discussed the possibility of 4 days training with a manual provided. The Mountain View hospital in Vryheid work closely with the Salvation Army in Swaziland and have over 300 CHWs, and would also be happy to be involved in any form of rollout/training/training of trainers etc. |
Year(s) Of Engagement Activity | 2016 |