Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study

BMC Public Health

Research Article

Merrick Zwarenstein¹  Salla Atkins²  Maria Rosaria Galanti³  Abha Rao⁴  Paul Jebaraj⁴  Arun S. Shet⁵  Maya Mascarenhas⁶ 

[1] Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada;Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm, Sweden;Hematology Research Division, St. Johns Research Institute, St. Johns National Academy of Health Sciences, 560034, Bangalore, India;Hematology Research Division, St. Johns Research Institute, St. Johns National Academy of Health Sciences, 560034, Bangalore, India;Department of Hematology/Medical Oncology, St. Johns Medical College and Hospital, Bangalore, India;Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;MYRADA, Bangalore, India;

关键词: Lay health workers;    Complex community intervention;    Pragmatic RCT;    Implementation;    Qualitative research;    Focus group discussion;    Childhood anemia;   

DOI  :  10.1186/s12889-017-4758-x

 received in 2017-05-17, accepted in 2017-09-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundLay 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.MethodsWe 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.ResultsSeveral 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.ConclusionThis 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 registrationThis trial was registered with ISRCTN.com (identifier: ISRCTN68413407) on 23 September 2013.

【 授权许可】

CC BY   
© The Author(s). 2017