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Van Iseghem T, Jacobs I, Vanden Bossche D, Delobelle P, Willems S, Masquillier C, Decat P. The role of community health workers in primary healthcare in the WHO-EU region: a scoping review. Int J Equity Health 2023; 22:134. [PMID: 37474937 PMCID: PMC10357780 DOI: 10.1186/s12939-023-01944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. METHODS This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. RESULTS Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. CONCLUSION Future research projects involving CHWs should detail their involvement and elaborate on CHWs' role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.
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Affiliation(s)
- Tijs Van Iseghem
- Interuniversity Centre for Health Economics Research (ICHER), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ilka Jacobs
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dorien Vanden Bossche
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- MENT Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sara Willems
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Caroline Masquillier
- 'Family Medicine and Population Health' - FAMPOP, Faculty of Medical Sciences & 'Centre for Family, Population and Health', Faculty of Social sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Decat
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Johnson LJ, Schopp LH, Waggie F, Frantz JM. Challenges experienced by community health workers and their motivation to attend a self-management programme. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144456 PMCID: PMC8831930 DOI: 10.4102/phcfm.v14i1.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022] Open
Abstract
Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.
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Affiliation(s)
- Levona J Johnson
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Bellville.
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Kim J, Kim H, Han HR. Chinese Immigrant Women's Experiences as Community Health Workers in Korea: A Focus Group Study. J Nurs Res 2021; 29:e172. [PMID: 34267164 DOI: 10.1097/jnr.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The number of immigrant women in Korea is rapidly increasing. Immigrant women in Korea experience a host of health problems associated with living in a new country. Community health workers (CHWs) may be effective at delivering health promotion programs to vulnerable groups such as recent immigrants. PURPOSE Qualitative analysis was performed to identify the main themes characterizing the experiences of CHWs in recommending and guiding preventive screening tests for immigrant women. METHODS This focus-group study was designed to investigate the experiences and perceptions of CHWs. We conducted interviews with 15 Chinese immigrant women who served as CHWs in a cancer screening program. We asked questions about the attitudes and perceptions that CHWs had from their research experiences. Each interview was audio-recorded and transcribed verbatim. RESULTS Three main themes emerged: (a) recognizing the need for preventive healthcare, (b) becoming the CHWs who help people to be healthy, and (c) challenges to overcome to make CHWs more active. The CHWs in this study were willing to help other Chinese immigrant women and to improve their competency to help more effectively. However, they recognized limitations on their ability to address problems when delivering a breast and cervical cancer screening program. CONCLUSIONS When training CHWs for immigrants in Korea, frequent opportunities for consultation should be provided during program delivery to facilitate troubleshooting and help CHWs overcome challenges. A program that utilizes CHWs for various minority groups is needed.
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Affiliation(s)
- Jiyun Kim
- PhD, RN, Associate Professor, School of Nursing, Gachon University, Incheon, Republic of Korea
| | - Hyang Kim
- MSN, RN, Doctoral Student, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hae-Ra Han
- PhD, RN, Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Cluley V, Martin G, Radnor Z, Banerjee J. Frailty as biographical disruption. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:948-965. [PMID: 33969903 DOI: 10.1111/1467-9566.13269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Biographical disruption positions the onset of chronic illness as a major life disruption in which changes to body, self and resources occur (Sociology of Health & Illness, 4, 1982, 167-182). The concept has been used widely in medical sociology. It has also been subject to critique and development by numerous scholars. In this paper, we build on recent developments of the concept, particularly those taking a phenomenological approach, to argue that it can also help in understanding other disruptive health-related experiences across the life course, in this case the onset of frailty. We draw on the findings of 30 situated interviews with frail older people, relating their experiences of frailty to the concept of biographical disruption. We show that frailty shares many similarities with the experience of chronic illness. Using the lens of biographical disruption to understand frailty also offers insights relevant to recent debates around both concepts, and on the continued relevance of the idea of biographical disruption given changing experiences of health and illness, including the circumstances in which biographical disruption is more and less likely to be experienced. Finally, we reflect on the potentials and limitations of applying the concept to a health-related condition that cannot be categorised as a disease.
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Affiliation(s)
- Victoria Cluley
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Zoe Radnor
- The Business School (formerly Cass), City, University of London, London, UK
| | - Jay Banerjee
- University Hospitals of Leicester, NHS Trust, Leicester, UK
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Newland J, Lestari D, Poedjanadi MN, Kelly-Hanku A. Co-locating art and health: engaging civil society to create an enabling environment to respond to HIV in Indonesia. Sex Health 2021; 18:84-94. [PMID: 33612154 DOI: 10.1071/sh20125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023]
Abstract
Background This paper will report on the successful co-location of a community-based arts and sexual health project that aimed to engage, educate and create testing, treatment and care pathways at a co-located mobile sexual health clinic and community-controlled art gallery in Yogyakarta, Indonesia. METHODS Mixed methods were used to evaluate the project, including a visitor (n = 1181) and artist (n = 85) log book, a convenience audience survey (n = 231), and qualitative semi-structured interviews (n = 13) with artists and audience to explore the effect of arts-based activities on access to sexual health information and services, and stigma and discrimination. RESULTS In total, 85 artists curated five separate exhibitions that were attended by 1181 people, of which 62% were aged ≤24 years. Gallery attendance improved awareness and participatory and interactive engagement with sexual health information through a medium described as interesting, fun, cool, and unique. The co-located clinic facilitated informal pathways to sexual health services, including HIV/AIDS testing, treatment, and care. Importantly, the project created shared understandings and empathy that challenged stereotypes and myths, reducing stigmatising beliefs and practices. CONCLUSIONS Arts-based programs are transformative and can be effectively implemented, replicated and scaled up in low-resource settings to create awareness and initiate for HIV prevention, testing, treatment, and care. Art-based health programs engages people in their communities, mobilises civil society, builds enabling environments to reduce stigma and discrimination and improves access to testing and prevention; essential features needed to end AIDS in Indonesia (and the Southeast Asia region) while improving the lives of those most vulnerable to infection.
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Affiliation(s)
- Jamee Newland
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, NSW, Australia; and Corresponding author.
| | - Dwi Lestari
- Perkumpulan Keluarga Berencana Indonesia, Yogyakarta, Indonesia
| | | | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, NSW, Australia; and Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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Rayment J, Sidhu M, Wright P, Brown P, Greenfield S, Jeffreys S, Gale N. Collaboration for Impact: Co-creating a Workforce Development Toolkit Using an Arts-based Approach. Int J Integr Care 2020; 20:11. [PMID: 32565761 PMCID: PMC7292144 DOI: 10.5334/ijic.5377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The identification, communication and management of health risk is a core task of Community Health Workers who operate at the boundaries of community and primary care, often through not-for-profit community interest companies. However, there are few opportunities or resources for workforce development. Publicly funded researchers have an obligation to be useful to the public and furthermore, university funding is increasingly contingent on demonstrating the social impact of academic research. Collaborative work with participants and other stakeholders can have reciprocal benefits to all but may be daunting to some researchers, unused to such approaches. METHODS This case study is an account of the co-creation of a (freely accessible) workforce development toolkit, as part of a collaboration between academics, community interest companies, patients and services users and arts practitioners. RESULTS Our collaborative group produced three short films, fictionalising encounters between Community Health Workers and their clients. These were used within a series of five discussion-led workshops with facilitator guidance to explore issues generated by the films. Two collaborating community-based, not-for-profit organisations piloted the toolkit before its launch. CONCLUSION We aim to encourage other academics to maximise the impact of their own research through collaborative projects with those outside of academia, including research participants and to consider the potential value of arts-based approaches to explore and facilitate reflection on complex tasks and tensions that make up daily work practices. Whilst publication of findings from such projects may be commonplace, accounts of the process are unusual. This detailed account highlights some of the benefits and challenges involved.
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Affiliation(s)
- Juliet Rayment
- Centre for Maternal and Child Health Research, City, University of London, GB
| | - Manbinder Sidhu
- Health Services Management Centre, University of Birmingham, GB
| | | | | | - Sheila Greenfield
- Medical Sociology, Institute of Applied Health Research, University of Birmingham, GB
| | | | - Nicola Gale
- Health Sociology and Policy, Health Services Management Centre, University of Birmingham, GB
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