Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines.

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES
Health Services Insights Pub Date : 2025-06-30 eCollection Date: 2025-01-01 DOI:10.1177/11786329251352658
Warren Dodd, Laura Jane Brubacher, Monica Bustos, Melinda Kelly Mijares, Krisha Lim-Mar, Lincoln Lau
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引用次数: 0

Abstract

Background: Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out.

Objectives: (1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out.

Methods: In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council's framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828).

Results: CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation.

Conclusion: This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process.

放大社区卫生工作者的声音来检查社区卫生计划的实施和规模:菲律宾的一项定性研究。
背景:扩大社区卫生规划有助于实现全民健康覆盖。社区卫生项目的实施者,如社区卫生工作者,拥有宝贵的见解和经验,可以为这些项目如何扩大和扩大提供信息。目标:(1)评估由卫生保健中心提供的社区卫生计划的实施经验和看法,该计划最近进行了改革,以扩大其规划和覆盖面(即扩大规模);(2)描述实施这一基于社区的健康计划的促进因素和障碍,以便为后续的扩展提供信息。方法:在2023年4月,对菲律宾内格罗斯东部6个地理区域的非政府组织主导的CHW项目进行了评估(n = 64次半结构化访谈)。在医学研究理事会复杂干预措施过程评价框架的指导下,采用混合归纳-演绎分析分析了数据。伦理批准由滑铁卢大学研究伦理委员会提供(证书编号:44828)。结果:卫生保健工作者认为,考虑到扩大的覆盖范围和提供的基本治疗,该计划的扩大版本更有用,更有影响力;然而,新的项目组件也需要大量的时间、精力和策略来实施,这为卫生工作者创造了新的机会成本。通过清晰的沟通结构和支持性的团体培训空间,促进了该计划扩大版的实施。健康护理人员原有的角色和社交网络,进一步促进了扩大版计划的实施。总体而言,卫生工作者利用新的个人层面和基于社区的战略来实施扩大规模的方案,参与者描述了影响方案实施的促进因素(如扩大覆盖面)和障碍(如增加时间和努力)。结论:这项研究有助于深入了解参与社区健康计划规模的个人如何经历这一过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Services Insights
Health Services Insights HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.60
自引率
0.00%
发文量
47
审稿时长
8 weeks
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