A Qualitative Study of the Role and Lived Experience of Community Health Workers within the HIV Treatment Interventions in Eswatini
Summary
Introduction
Community Health Workers (CHWs) are recognized as an essential global workforce to address the gap in healthcare services, especially in resource-constrained countries. However, they often lack structural support and formal recognition. They are also found to undertake multiple roles in their work and perform extra responsibilities. Existing public health literature focuses mainly on evaluating CHWs' performance and effectiveness and tends to neglect the importance of investigating their experiences. As CHWs in Eswatini face similar challenges as those of other countries, this thesis adopted a phenomenological approach and the role theory to understand how RHMs experienced their work and practiced their multiple roles.
Methods
This thesis used existing data collected as part of the HIV treatment interventions, the MaxART program, in Eswatini to investigate Community-Based Volunteers' (CBVs) experience implementing the study. 27 semi-structured and in-depth interviews were conducted with CBVs using a topic list covering various aspects of their roles, perceptions of HIV, and involvement in implementing the EAAA project. Only 17 interviews with Rural Health Motivators (RHMs), the largest represented group of CBVs, were eventually analyzed. Inductive thematic analysis and a phenomenological approach were adopted for data analysis.
Results
This study added new understandings of RHMs' lived experience and how they practiced their roles. Informed by the role theory, the findings revealed RHMs’ various role problems, such as role ambiguity, role overload, role identity, and role insufficiency, while performing their duties. The findings indicated that RHMs did more than their formal obligations, including providing food and following up on patients' medical records. The findings also highlighted RHMs' emotional work, such as providing support and handling negative reactions from the community. Generally, despite challenges, RHMs were recognized by community members for their efforts.
Conclusion
This study underscores a need for further research on RHMs' overlooked emotional work and advocates for increased diversity within RHM programs. Policy implications include providing psychological support and training on interpersonal relationships to support RHMs better. Ultimately, the study emphasizes the importance of considering RHMs' perspectives and experiences to construct a more sustainable healthcare system and support RHMs effectively.