title: Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.
abstract: Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.|The Ontario HIV Treatment Network, Toronto, Ontario, Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Rachlis
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Juddy
authors.initials: J
authors.lastname: Wachira
authors.affiliation: Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, United States.
authors.forename: Becky
authors.initials: B
authors.lastname: Genberg
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Koech
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Regina
authors.initials: R
authors.lastname: Kamene
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Jackie
authors.initials: J
authors.lastname: Akinyi
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.|Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003150:Community Health Workers; D019468:Disease Management; D005260:Female; D015658:HIV Infections; D006801:Humans; D006973:Hypertension; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D014376:Tuberculosis; D055815:Young Adult