Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study
| Autor: | Abha Rao, Arun S. Shet, Salla Atkins, Maya Mascarenhas, Maria Rosaria Galanti, Merrick Zwarenstein, Paul Jebaraj |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Attitude of Health Personnel Psychological intervention Childhood anemia India Day care Focus group discussion 03 medical and health sciences 0302 clinical medicine Nursing Pragmatic RCT Intervention (counseling) Qualitative research medicine Cluster Analysis Humans 030212 general & internal medicine Child Community Health Workers business.industry Complex community intervention lcsh:Public aspects of medicine Public health Public Health Environmental and Occupational Health Lay health workers lcsh:RA1-1270 Anemia Focus group 3. Good health Family medicine Implementation Community health Female Rural Health Services Biostatistics business 030217 neurology & neurosurgery Research Article |
| Zdroj: | BMC Public Health BMC Public Health, Vol 17, Iss 1, Pp 1-9 (2017) |
| ISSN: | 1471-2458 |
| Popis: | Background Lay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs’ acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation. Methods We conducted a qualitative study alongside a cluster randomized controlled trial evaluating a complex community intervention for childhood anemia control in Karnataka, South India. Focus group discussions (FGDs) were conducted with trained LHWs assigned to deliver the educational intervention. These were complemented by non-participant observations of LHWs delivering the intervention. Transcripts of the FGDs were translated and analyzed using the framework analysis method. Results Several factors made the intervention acceptable to the LHWs and facilitated its implementation including pre-implementation training modules, intervention simplicity, and ability to incorporate the intervention into the routine work schedule. LHWs felt that the intervention impacted negatively on their preexisting workload. Fluctuating relationships with mothers weakened the LHWs position as providers of the intervention and hampered efficient implementation, despite the LHWs’ highly valued position in the community. Modifiable barriers to the successful implementation of this intervention were seen at two levels. At a broader contextual level, hindering factors included the LHW being overburdened, inadequately reimbursed, and receiving insufficient employer support. At the health system level, lack of streamlining of LHW duties, inability of LHWs to diagnose anemia and temporary shortfalls in the availability of iron supplements constituted potentially modifiable barriers. Conclusion This qualitative study identified some of the practical challenges as experienced by LHWs while delivering a community health intervention in India. Methodologically, it highlights the value of qualitative research in understanding implementation of complex community interventions. On the contextual level, the results indicate that efficient delivery of community interventions will require streamlining of LHW workloads and improved health system infrastructure support. Trial registration This trial was registered with ISRCTN.com (identifier: ISRCTN68413407 ) on 23 September 2013. |
| Databáze: | OpenAIRE |
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