A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial

Datos Bibliográficos

ID19593711
AutoresLarske M Soepnel (0000-0002-0076-7477, South African Medical Research Council, autor de correspondencia), Shane A Norri (0000-0001-7124-3788, South African Medical Research Council, autor de correspondencia), Khuthala Mabetha (0000-0002-7233-5913, South African Medical Research Council, autor de correspondencia), Molebogeng Motlhatlhedi (0000-0003-1242-0259, South African Medical Research Council, autor de correspondencia), Nokuthula Gloria Nkosi (0000-0002-3227-1775, South African Medical Research Council, autor de correspondencia), Nokuthula Nkosi, Stephen J Lye (0000-0002-3305-4406, University of Toronto, autor de correspondencia), Catherine E Draper (0000-0002-2885-437X, South African Medical Research Council, autor de correspondencia)
EditoresHannah Hogan Leslie
Año2024
Volumen4
Número3
Páginase0002578
Fecha de publicación2024-03-14
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaPLOS Global Public Health (JOURNAL)
Identificadores de la revistaISSN: 2767-3375 • E-ISSN: 2767-3375
EditorialPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002578
PMID38483881
OpenAlexW4392799569
IdiomaEN
Citas recibidas3
Referencias citadas38

Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali , from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants’ socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali , such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali , for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871 , Registered March 27, 2019

Family medicine · Focus group · Health care · Health literacy · Political science · Public health · Qualitative research · Randomized controlled trial · Sociology · Thematic analysis · Global Maternal and Child Health · Health Policy Implementation Science · Medicine · Nursing · Primary Care and Health Outcomes · Psychology · Gerontology