‘I have a lot of faith in her’: Value of community health workers in addressing family planning in rural Ghana

ABSTRACT

In rural settings with shortages in trained health care workers, community health workers (CHWs) play an important role in the delivery of health care services. The Ghana Health Service initiated a national CHW programme in 2016 to expand health services to rural populations. This study explored the perceived role and value of CHWs in addressing family planning issues in the Amansie West district of Ghana. The study included in-depth interviews (IDIs) with 28 women in the community, ages 18–49, and 30 CHWs. Using inductive thematic analysis, IDIs were coded to explore opinions on the CHWs’ role and perceived value in the delivery of family planning. Participants explained that CHWs provided family planning as part of a healthcare package through household visits and referrals to government services. The value of CHWs in delivering family planning was seen in confidentiality, accessibility, and comfort. Participants recommended an enlarged CHW workforce with a range of commodities and programmatic support. The findings suggest CHWs play an important role in promoting family planning, by serving as a bridge between the community and clinics. In rural communities where resources are scarce, CHWs are an invaluable part of the broader healthcare system.     

Health characteristics and outcomes of caregivers in the United States: An Analysis of the 2017 Health Information National Trends Survey (HINTS)

BackgroundCaregivers are essential for assisting people with disabilities to fully participate in their communities. Past research has primarily focused on family caregivers in the U.S. providing care to older adults rather than children and adults with disabilities.ObjectiveThis paper examines the demographic and health characteristics of caregivers of children and adults with disabilities across the lifespan using data from the 2017 Health Information National Trends Survey (HINTS).MethodsChi square, t-test, linear and logistic regression analyses show differences between caregivers and non-caregivers related to gender, age, employment, and specific health outcomes.ResultsOf 3285 respondents, 18% self-identified as caregivers of children or adults with disabilities (n = 546). Almost one-third of all caregivers reported being diagnosed with depression or an anxiety disorder as compared to one-fifth of non-caregivers. Psychological distress was associated with an increased risk for a diagnosis of depression/anxiety. We also found that distress decreased with age when controlling for other factors.ConclusionThis paper increases knowledge of a growing segment of family caregivers providing care for members with disabilities across the lifespan. Research and policy needs are discussed.     

Association of Food Insecurity and Food Addiction Symptoms: A Secondary Analysis of Two Samples of Low-Income Female Adults

BackgroundHousehold food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.ObjectiveOur aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.DesignSecondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.Participants/settingParticipants in study 1 (n = 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n = 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.Main outcome measuresThe primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.Statistical analysisMultivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.ResultsIn study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P = .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P = .045).ConclusionsThese findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.     

CSHCN with hearing difficulties: Disparities in access and quality of care

BackgroundHearing difficulties (HD) affect a sizable minority of children in the United States and can have a significant impact on child development. Children with HD may face barriers around language development, communication abilities, learning, and social interactions, which in turn can affect multiple aspects of their lives.Objective/HypothesisLittle is known about the extent to which children with HD have access to a system of care and we hypothesize that this population may experience significant unmet needs.MethodsIn this cross-sectional study, using bivariate and multivariable regression models, we analyzed data from the 2009/2010 National Survey of Children with Special Health Care Needs (NS-CSHCN). Selected survey items were used to assess health and healthcare characteristics of CSHCN with some level of HD (n = 2,315) compared to those without HD (n = 37,851). The study sample included 40,242 CSHCN aged 0–17 years, whose caregivers responded to the survey.ResultsApproximately 694,000 CSHCN in the U.S. were reported to have any level of HD, representing 6.3% of the CSHCN population. Compared to CSHCN without HD, those with HD were less likely to have access to a medical home, community services, or have adequate health insurance.ConclusionsSignificant deficits in medical home access, adequate insurance, and accessibility of community-based services are evident for CSHCN with HD. Families having knowledge of how and when to access community services and partner with providers in their child's health care is important for the overall health and wellbeing of this subpopulation of CSHCN.     

Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents

SETTING:Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV.OBJECTIVES:To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents’ perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months’ post-HIV diagnosis.DESIGN:We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes).RESULTS:Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers.CONCLUSION:This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.     

Designing and evaluating a health education session on respiratory infections addressed to caregivers of children under three years of age attending day-care centres in Porto,Portugal: A community-based intervention

Background: Acute respiratory infections (ARI) are common in children, increasing the pressure on clinicians to prescribe antibiotics and affecting public health

Objectives: This study aimed to design a health education session (HES) for caregivers of children, and to evaluate its effects on caregivers’ needs, as well as on their knowledge and attitudes concerning ARI.

Methods: A generalized model of developing, implementing and evaluating a community-based intervention was followed, including caregivers of children under three years of age. Caregivers were randomly distributed into an intervention group (IG) (n?=?41) and a control group (CG) (n?=?51) and the HES was administered to the IG. The caregivers’ needs as well as knowledge of and attitudes to ARI were evaluated in both groups, before (M0) and two months after the HES (M1).

Results: At M0 the caregivers from both groups had ‘some or great need’ about all HES domains; at M1 the caregivers in the IG expressed ‘no or low need’, whereas the CG maintained ‘some or great need’ about all HES domains (0.011 ≤ P?≤?.047). Concerning caregivers’ knowledge of and attitudes to ARI, at M1 there was a higher frequency of caregivers with right answers in the IG than in the CG (IG =7.5?±?1 versus CG =6.0?±?2; P?=?.000). Those differences occurred in domain (e) nasal clearance techniques, revealing a higher percentage of caregivers who used correctly nasal irrigation (P?=?.000), nasal aspirators (0.000 ≤P?≤?.001) and nebulization (P?=?.000) in IG.

Conclusion: The HES met the caregivers’ needs regarding ARI and increased their knowledge and attitudes towards ARI, especially regarding nasal clearance techniques.     

"Community ambassadors" for South Asian elder immigrants: Late-life acculturation and the roles of community health workers

Elder immigrants face multiple barriers to accessing health care and other basic services. The Community Ambassador Program for Seniors (CAPS), based in Fremont, California, trains volunteer "ambassadors" from several ethnic and faith communities to perform information and referral services for elders, particularly immigrants. The purpose of this study is to examine the roles of ambassadors in ecologic context as community health workers (CHWs) for clients undergoing late-life acculturation. Ambassadors from three different communities, all of South Asian heritage, were interviewed using a semi-structured guide. 20 out of 23 ambassadors from these communities participated, from December 2008 to December 2009. Data collection and analysis followed grounded theory methodology. Results are presented as an integrated explanatory model, with three major components: (1) acculturative stress, particularly within elders' families; (2) polygonal relationships, a construct that includes elders, their caregivers, CHWs, and service providers, and builds on the notion of a "geriatric triad" (Adelman, Greene, & Charon, 1987); and (3) role hybridity, a novel explanation for CHWs' social niche. Ambassadors mediated elder clients' acculturation both inside and outside elders' families. As such, ambassadors worked in polygonal relationships with elder clients and elders' children, rather than simply working in dyads with elder clients themselves. In the CAPS context, this polygonal framework integrates intra-familial and extra-familial acculturative dynamics into a single relational model. Within these relationships, CHWs exhibited hybridity of social roles, integrating familial and professional attributes, but fully achieving neither familial nor professional status. Practical implications, including importance of outreach to elders' children, accessibility of social programs, and the consequences of role hybridity as a property of CHW identity and function, are discussed.     

Opportunities for community health workers to contribute to global efforts to end tuberculosis

ABSTRACT

Tuberculosis (TB) has emerged as the leading infectious cause of death globally. New paradigms are needed to reduce TB rates and mortality. Programs harnessing the potential of community health workers (CHWs) to enhance TB prevention and care have shown great promise. In this perspective article, we review the history of CHW-based efforts to prevent and treat TB, present evidence illustrating the effectiveness of CHWs across the entire cascade of TB care, and outline additional opportunities for CHWs to address challenges particular to the TB pandemic. Despite many promising studies, knowledge gaps persist and we suggest an agenda for future research on the role of CHWs in TB prevention and care.     

Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya

ObjectivesThis paper examines trends and underlying causes of attrition among volunteer community health workers in home-based care for people living with HIV and AIDS in western Kenya.MethodsEthnographic data were collected between January and November 2006 through participant observation, focus group discussions and in-depth interviews with 30 CHWs, NGO staff and health care providers and 70 PLWHA.ResultsAn attrition rate of 33% was observed among the CHWs. The reasons for dropout included: the cultural environment within which CHWs operated; lack of adequate support from area NGOs; poor selection criteria for CHWs; and power differences between NGO officials and CHWs which fostered lack of transparency in the NGOs’ operations.ConclusionsIn order to achieve well functioning and sustainable HBC services, factors which influence retention/dropout of CHWs should be addressed taking into account the socio-cultural, programmatic and economic contexts within which CHW activities are implemented.     

Childhood vision impairment,hearing loss and co-occurring autism spectrum disorder

BackgroundLimited population-based data on prevalence of childhood vision impairment (VI) and hearing loss (HL), and their co-occurrence with autism spectrum disorder (ASD) exists.ObjectiveTo examine prevalence and characteristics of VI, HL and co-occurring ASD among 8-year-olds in metropolitan Atlanta 2000–2008.MethodsWe used data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program. Prevalence, birth and parental characteristics, presence and severity of other co-occurring developmental disabilities, and age of earliest identification of ASD, were examined for children with VI and HL, by co-occurring ASD.ResultsVI and HL prevalences were 1.2 and 1.3 per 1000 8-year-olds, respectively. Approximately 6–7% of children with VI or HL had co-occurring ASD. Children with VI or HL with co-occurring ASD differed from those without co-occurring ASD by select birth characteristics and the presence of other co-occurring DDs. The median age of earliest known ASD diagnosis was significantly later among children with VI and ASD compared to children with ASD without VI (79 vs. 56 months). Children with HL and ASD were first evaluated by a community provider significantly earlier than those with ASD without HL (40 vs. 50 months).ConclusionsThe frequency of co-occurring ASD with VI and HL is higher than the population prevalence of ASD. The significant delays in diagnosis of ASD in children with VI and lack of earlier diagnosis of ASD among children with HL despite earlier evaluation highlight the importance of developing screening tools for early identification of ASD among children with VI and HL.     

Person-reported perspectives on support availability for people with disabilities during the COVID-19 pandemic in Quebec

ObjectivesTo identify the perception of the availability of community support and the support needs of autistic people and people with disabilities, from their own perspectives and from those of their caregivers at the time of the COVID-19 pandemic in Quebec, to assess the association between the available support and the perceived stress levels to evaluate the role of perceived social support as a potential buffer of this association.MethodsA total of 315 respondents participated in a 4-min online survey across the province of Quebec by snowball sampling. Community support was defined as availability of adapted healthcare, adapted information, adapted educational services and community services.ResultsThe community support and services during the COVID-19 pandemic were not available or were not sufficiently adapted to their needs. About 40% of autistic people or people with disabilities and 44% of their caregivers perceived their days as being quite stressful or extremely stressful. This is twice the rate of that of the general population in non-pandemic time. Nevertheless, social supports can play a mediating role in attenuating the effects of the absence of adapted services on the stress level of this vulnerable population.ConclusionThe non-availability of adapted services was related to an increase in the stress level in this population. Our study adds that other than social support, adapted healthcare/tele-healthcare and in-home support services could reduce the impact of the pandemic on the stress level of autistic people and people with disabilities. Adapted educational services and necessary equipment for online education for people without resources could reduce the impact on the stress level in caregivers. People with disabilities and their caregivers are one of the most vulnerable groups in our society. Public health measures of containment and mitigation need to consider more their specific needs.     

Caregiver Perspectives During the Post Inpatient Hospital Transition: A Mixed Methods Approach

Background

Knowledge of caregiver perspectives of their psychosocial resources and needs during the post inpatient psychiatric hospitalization is limited. Examining caregivers’ perspectives of the transition period may be a critical step in improving the transition success of children with emotional and behavioral disorders. Using quantitative and qualitative methods, we investigated the psychosocial resources and needs of caregivers after a child inpatient hospitalization.

Objective

This study sought to examine the psychosocial resources of caregivers of children leaving intensive psychiatric care and participating in a post-inpatient transition program, and to describe their reported needs at home and school.

Methods

Forty-four caregivers were recruited from the child and adolescent psychiatric inpatient units of two hospitals (one urban, one suburban). We utilized a partially mixed concurrent equal status design for mixed-methods analysis. Qualitative data were analyzed using consensual qualitative research methodology.

Results

Caregivers reported high levels of strain, child symptomatology, and low levels of empowerment and social support. Their satisfaction with school and mental health services were mixed. Caregivers identified a need for increased knowledge of behavior management strategies, improved caregiver/child relationship, more emotional support, and increased access to services for their children. Areas of concern in the school setting included social–emotional functioning, learning, access to school services, and advocacy.

Conclusion

These findings expand our knowledge of caregivers’ psychosocial resources and needs during their children’s inpatient psychiatric hospitalization and subsequent transition to home and school. As research in this area develops, we suggest that incorporating caregivers’ needs into transition planning may result in more effective and acceptable interventions for families.

     

‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda

ABSTRACT

Understanding the experiences of community health workers (CHWs) through the use of participatory visual methods (PVMs) has been relatively underexplored. One such PVM is photovoice, which involves the capture of photographic images related to issues of social importance. In this study, we explore challenges faced by eight CHWs in Mukono District, Uganda through the use of photovoice. Over a six-week period, CHWs captured 62 relevant photographs. Subsequent individual interviews and group discussions were held with the CHWs regarding the content of the photographs. Using traditional content analysis, a range of themes related to perceived challenges faced by the CHWs were highlighted, including poor infrastructure, insufficient on-going training and supervision, relationships with other health professionals and equipment supplies. Suggestions were raised as to why such challenges existed and how they could be addressed; mainly through increased roles of the government and supporting NGOs. Overall, photovoice was generally a feasible method to highlight the challenges faced by CHWs, however community acceptability regarding image capture and consent taking may prove challenging, given past historical experiences. The use of photovoice in this study highlighted the need to address the multiple and complex challenges faced by CHWs in order to help them fulfil their roles.     

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.     

The role of community health workers in improving child health programmes in Mali

Background  

Mortality of children under the age of five remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through community health workers (CHWs) is among the key strategies to improve child health. The objective of this study was to assess the performance of CHWs in the promotion of basic child heath services in rural Mali.     

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children’s Experiences and Related Coping Strategies

BackgroundFood insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.ObjectiveTo critically explore the psychological distress associated with children’s food insecurity using children’s own reports of their experiences.DesignIn-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.Participants/settingSixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.ResultsChildren discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents’ well-being, anger and frustration about not having enough food, embarrassment about their family’s food situation, strain on the family’s dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family’s food situation, and appreciating their parents for providing food and resources.ConclusionsFood insecurity contributes to children’s psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children’s growth and development and deserves investigation in future studies.     

Becoming and remaining community health workers: Perspectives from Ethiopia and Mozambique

Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers (CHWs) in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010. Participant observation and in-depth interviews were used to understand the life histories that lead people to become CHWs, their relationships with intended beneficiaries after becoming CHWs, and their social and economic aspirations. People in Ethiopia and Mozambique have faced similar political and economic challenges in the last few decades, involving war, structural adjustment, and food price inflation. Results suggest that these challenges, as well as the socio-moral values that people come to uphold through the example of parents and religious communities, influence why and how men and women become CHWs. Relationships with intended beneficiaries strongly influence why people remain CHWs, and why some may come to experience frustration and distress. There are complex reasons why CHWs come to seek greater compensation, including desires to escape poverty and to materially support families and other community members, a sense of deservingness given the emotional and social work involved in maintaining relationships with beneficiaries, and inequity vis-à-vis higher-salaried elites. Ethnographic work is needed to engage CHWs in the policy process, help shape new standards for CHW programs based on rooting out social and economic inequities, and develop appropriate solutions to complex CHW policy problems.     

Health Utility Assessment Using EQ-5D among Caregivers of Children with Autism

ObjectivesHealth utility of caregivers of children with autism was assessed by using the EuroQol five-dimensional (EQ-5D) questionnaire. Utility scores of autism caregivers were compared with norms for the general adult US population. Predictors of health utility were identified.MethodsA cross-sectional online survey design was used. Caregivers registered with the Interactive Autism Network were approached for participation in the online survey. Three hundred and sixteen usable responses were received. Health utility among caregivers was calculated and compared with the US population norms by using Student’s t test. Problems in EQ-5D questionnaire domains and utility scores were analyzed by study characteristics by using Kruskal-Wallis analysis of variance. Factors predicting health utility were identified by using ordinary least square regression.ResultsRoughly 94% of the caregivers who participated in the study were females. As compared to their counterparts in the general US population, caregivers who were aged 18 to 44 years and were females had lower utility scores (P < 0.001). Significant differences in utility scores were observed among caregivers. When compared to males, females had lower health utility. Caregivers of lower socioeconomic status had lower utility scores and reported more problems in EQ-5D questionnaire domains than did those from higher socioeconomic status. Caregiver burden was inversely correlated with health utility. Caregiver physical and mental health status, objective strain, education, and relationship with the care recipient were found to significantly predict health utility (adjusted R² ~57%).ConclusionsAutism caregivers had lower health utility than did the general adult US population. There is an immediate need to address health concerns among this growing population.     

Communication and behavioural disorders among children with hearing loss increases risk of mental health disorders

Objective : This study examines the mental health and associated risk factors of children with hearing loss. Methods : A cross‐sectional analysis of the impact of hearing loss among Australian children using data drawn from Wave 1 of the Longitudinal Study of Australian Children (2004) (LSACs) (n=4589). LSACs provides data which assesses family circumstances, children's hearing problems, chronic health conditions, social and emotional difficulties, communications disorders and language, motor skills and educational outcomes. Outcomes for children aged 4–5 years identified with hearing loss (n=93) were compared with 4,496 children without hearing loss. Results : Children with hearing loss showed elevated prevalence across most dimensions of emotional and behavioural difficulties, and on indicators of communication disorders, language and cognitive development, and motor skills. Reduced receptive language skills and increased difficulties understanding others were predictive of increased psychosocial difficulties in children with hearing problems. Conclusion : Australian children with hearing problems face multiple concurrent health and developmental problems. Moreover, children with hearing problems exhibit behavioural problems when they do not understand what is going on around them. Without appropriate interventions, these children are at risk of developing mental health disorders. Implications : An epidemiological study of hearing in children is indicated. Children with receptive hearing problems require access to amplification, communication training, and psychosocial support. Attention must also be given to building design to reduce physical barriers to hearing.