title: Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa.
abstract: BACKGROUND
  Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks.
  
  
  OBJECTIVE
  The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network.
  
  
  METHODS
  We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter - 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants' references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants.
  
  
  RESULTS
  The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients' care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards.
  
  
  CONCLUSIONS
  CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to the client, and preferences of the clients remain central to the process of negotiating care.
authors.affiliation: Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Moshabela@ukzn.ac.za.
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
authors.affiliation: International Centre for Health Systems Research and Education, Department for Health Evidence, Radboud University, Nijmegen, Nijmegen, The Netherlands.
authors.forename: Ilona
authors.initials: I
authors.lastname: Sips
authors.affiliation: International Centre for Health Systems Research and Education, Department for Health Evidence, Radboud University, Nijmegen, Nijmegen, The Netherlands.
authors.forename: Francoise
authors.initials: F
authors.lastname: Barten
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D003150:Community Health Workers / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D011369:Professional-Patient Relations; D012424:Rural Population; D012944:Social Support; D013019:South Africa
keywords: South Africa; community health worker; home-based care; patient-centred care; primary caregiver; quality of care; social support networks