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

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dc.contributor.authorNorris, Shane A.
dc.contributor.authorSoepnel, Larske M.
dc.contributor.authorMabetha, Khuthala
dc.contributor.authorMotlhatlhedi, Molebogeng
dc.contributor.authorNkosi, Nokuthula
dc.contributor.authorLye, Stephen
dc.contributor.authorDraper, Catherine E.
dc.date.accessioned2024-08-14T09:16:03Z
dc.date.available2024-08-14T09:16:03Z
dc.date.issued2024
dc.description.abstractCommunity 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.
dc.description.sponsorshipSouth African Medical Research Council (SAMRC).
dc.description.sponsorshipCanadian Institutes of Health Research (CIHR).
dc.description.sponsorshipDSI-NRF Centre of Excellence (CoE) in Human Development at the University of the Witwatersrand, Johannesburg.
dc.description.submitterPM2024
dc.facultyFaculty of Health Sciences
dc.identifier0000-0001-7124-3788
dc.identifier.citationSoepnel LM, Norris SA, Mabetha K, Motlhatlhedi M, Nkosi N, Lye S, et al. (2024) A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial. PLOS Glob Public Health 4(3): e0002578. https://doi.org/10.1371/journal.pgph.0002578
dc.identifier.issn2767-3375 (online)
dc.identifier.other10.1371/journal.pgph.0002578
dc.identifier.urihttps://hdl.handle.net/10539/40101
dc.journal.linkhttps://journals.plos.org/globalpublichealth/
dc.journal.titlePLOS Global Public Health
dc.language.isoen
dc.publisherPublic Library of Science
dc.relation.ispartofseriesVol. 4; Issue 4
dc.rights© 2024 Soepnel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.
dc.schoolSchool of Clinical Medicine
dc.subjectCritical Care
dc.subjectPublic health
dc.subjectEnvironmental health
dc.subjectOccupational health
dc.subjectIntensive Care Medicine
dc.subject.otherSDG-16: Peace, justice and strong institutions
dc.subject.otherSDG-17: Partnerships for the goals
dc.titleA qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial
dc.typeArticle
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