title: Reactions of community members regarding community health workers' activities as a measure of the impact of a training program in Amazonas, Brazil.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.
  
  
  METHODS
  Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
  
  
  RESULTS
  Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to "provide strong medicine" (P < 0.001) and "provide injections" (P < 0.001), and came to appreciate "go to hospital with a sick person" (P = 0.031) as a function and role of CHWs.
  
  
  CONCLUSIONS
  The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.
authors.affiliation: Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Kawasaki
authors.affiliation: Health and Development Services, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sadamori
authors.affiliation: Training Advisor for Community Health Workers, Manicoré, Brazil.
authors.forename: Terezinha
authors.initials: T
authors.lastname: Ferreira de Almeida
authors.affiliation: The Hirayama Ikuo Volunteer Center, Waseda University, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Akiyoshi
authors.affiliation: Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Nishihara
authors.affiliation: Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yoshimura
authors.affiliation: Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ohnishi
keywords: Amazon; community health worker; satisfaction; training