Publisher: Co-Action Publishing
Journal: Global Health Action
Subjects: Original Article, home-based care, role identity theory, RA1-1270, community health worker; role identity theory; home-based care, community health worker, Public aspects of medicine
Background: Community health workers (CHWs) are an integral resource in many health systems, particularly in resource-poor settings. Their identities – ‘who’ they are – play an important role in their hiring, training, and retention. We explore the perceptions, experiences, and identities of CHWs as they adopt a CHW role in rural South Africa, using ‘role identity theory’.Design: From April to December 2010, we conducted 18 semi-structured interviews with CHWs volunteering in non-governmental home-based care (HBC) organisations in one rural sub-district in South Africa. The role identity theory framework was used to understand the work of CHWs within their communities, addressing themes, such as entry into, and nature of, caring roles, organisational support, state resourcing, and community acceptability. A thematic content analysis was used to analyse the collected data.Results: The study found that CHWs usually begin their ‘caring work’ before they formally join HBC organisations, by caring for children, neighbours, mothers, fathers, friends, and the community in some way. CHWs felt that becoming a health worker provided an elevated status within the community, but that it often led community members to believe they were able to control resources. The key role identities assumed by CHWs, as they sought to meet patients’ and their own needs, were a complex mix of community ‘insider’, ‘outsider’, and ‘broker’. Each of these role identities served as a unique way to position, from the CHW's perspective, themselves and the community, given the diversity of needs and expectations.Conclusions: These role identities reveal the tensions CHWs face as ‘insider’ members of the community and yet at times being treated as ‘outsiders’, who might be regarded with suspicion, and at the same time, appreciated for the resources that they might possess. Understanding role identities, and how best to support them, may contribute to strategies of retention and sustainability of CHW programmes, as their formalisation in different contexts continues to grow.Keywords: community health worker; role identity theory; home-based care(Published: 18 September 2015)Citation: Glob Health Action 2015, 8: 28045 - http://dx.doi.org/10.3402/gha.v8.28045
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- 1. Lehmann U, Sanders D. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization; 2007.
- 2. Tsolekile LP, Puoane T, Schneider H, Levitt NS, Steyn K. The roles of community health workers in management of noncommunicable diseases in an urban township. Afr J Prim Health Care Fam Med 2014; 6: 693 701.
- 3. Gitomer S. Care in the home: findings of situational analysis. Acornhoek: Rural and AIDS Development Action Research programme; 2010 unpublished.
- 4. Schneider H, Blaauw D, Gilson L, Chabikuli N, Goudge J. Health systems and access to antiretroviral drugs for HIV in Southern Africa: service delivery and human resources challenges. Reprod Health Matter 2006; 14: 12 23.
- 5. Singh J, Sachs D. 1 million community health workers in subSaharan Africa by 2015. Lancet 2013; 382: 363 5.
- 6. Schneider H, Lehmann U. Lay health workers and HIV programmes: implications for health systems. AIDS Care 2010; 22: 60 7.
- 7. WHO (2008). Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization.
- 8. PHC re-engineering in South Africa: are we making progress. PHASA Newsletter. 2012. Available from: https://www.phasa. org.za/phc-re-engineering-in-south-africa-are-we-making-progress [cited 5 January 2015].
- 9. Mohapi MC, Basu D. PHC re-engineering may relieve overburdened tertiary hospitals in South Africa. S Afr Med J 2012; 102: 79 80.
- 10. DoH (2011). The 2010 national antenatal sentinel HIV & syphilis prevalence survey in South Africa. Pretoria: National Department of Health.
- 11. DoH/DSD (2009). Community care worker policy management framework. Pretoria: Department of Health.
- 12. Hongoro C, McPake B. How to bridge the gap in human resources for health. Lancet 2004; 364: 1451 6.
- 13. Zulliger R, Moshabela M, Schneider H. ''She is my teacher and if it was not for her I would be dead'': exploration of rural South African community health workers' information, education and communication activities. AIDS Care 2014; 26: 626 32.
- 14. Squires A, O'Brien MJ. Becoming a promotora: a transformative process for female community health workers. Hispanic J Behav Sci 2012; 34: 457 73.
- 15. Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One 2013; 8: e54978.
- 16. Perez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. Am J Public Health 2008; 98: 11 14.
- 17. Akintola O. Defying all odds: coping with the challenges of volunteer caregiving for patients with AIDS in South Africa. J Adv Nurs 2008; 63: 357 65.
- 18. Kang'ethe SM. Challenges impacting on the quality of care to persons living with HIV/AIDS and other terminal illnesses with reference to Kanye community home-based care programme. SAHARA J 2009; 6: 24 32.
- 19. Goudie C. Equal treatment-community health care workers treatment action campaign. Cape Town: Treatment Action Campaign; 2011.
- 20. Kironde S, Klaasen S. What motivates lay volunteers in high burden but resource-limited tuberculosis control programmes? Perceptions from the Northern Cape province, South Africa. Int J Tuberc Lung Dis 2002; 6: 104 10.
- 21. Akintola O. What motivates people to volunteer? The case of volunteer AIDS caregivers in faith-based organization in KwaZulu-Natal, South Africa. Health Policy Plann 2011; 26: 53 62.
- 22. Schneider H, Hlophe H, Van Rensburg D. Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy Plann 2008; 23: 179 87.
- 23. Siebert DC, Siebert CF. Help seeking among professionals: a role identity perspective. Am J Orthopsychiatry 2007; 77: 49 55.
- 24. Farmer SM, Tierney P, Kung-Mcintyre K. Employee creativity in Taiwan: an application of role identity theory. Acad Manage J 2003; 46: 618 30.
- 25. Simpson B, Caroll B. Re-viewing 'role' in processes of identity construction. Organization 2008; 15: 29 50.
- 26. Stets J, Burke PJ. Identity Theory and Social Identity Theory. Soc Psychol Q 2000; 63: 224 37.
- 27. Petkus E. The creative identity: creative behaviour from the symbolic interactionist perspective. J Creat Behav 1996; 30: 188 96.
- 28. Moshabela M, Gitomer S, Qhibi B, Schneider H. Development of non-profit organisations providing health and social services in rural South Africa: a three-year longitudinal study. PLoS One 2013; 8: e83861.
- 29. Sips I, Mazanderani AH, Schneider H, Greeff M, Barten F, Moshabela M. Community care workers, poor referral networks and consumption of personal resources in rural South Africa. PLoS One 2014; 9: e95324.
- 30. Smit J. Process indicators. Durban: Health Systems Trust; 2009.
- 31. Bushbuckridge Local Municipality (2011). Integrated development plan: IDP 2011 2016. Nelspruit: Bushbuckridge Local Municipality.
- 32. Bushbuckridge Local Municipality (2014). Bushbuckridge local municipality 2014/15 final integrated development plan. Nelspruit: Bushbuckridge Local Municipality.
- 33. Schilling J. On the pragmatics of qualitative assessment: designing the process for content analysis. Eur J Psychol Assess 2006; 22: 28 37.
- 34. Kolbe RH, Burnett MS. Content analysis research: an examination of application for improving research reliability. J Consum Res 1991; 18: 243 64.
- 35. Deaux K. Social identity. New York: Academic Press; 2001.
- 36. Greenspan JA, McMahon SA, Chebet JJ, Mpunga M, Urassa DP, Winch PJ. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Resour Health 2013; 11: 52.
- 37. Maes K, Kalofonos I. Becoming and remaining community health workers: perspectives from Ethiopia and Mozambique. Soc Sci Med 2013; 87: 52 9.
- 38. McAllister P. Ubuntu beyond belief in Southern Africa. J Soc Anthropol Cult Stud 2009; 6: 1 10.
- 39. Kaler A, Watkins SC. Disobedient distributors: street-level Bureaucrats and would-be patrons in community-based family planning programs in rural Kenya. Stud Fam Plann 2001; 32: 254 67.
- 40. Blanchard C, Grant M, Haskins L, Horwood C, Mntambo N, Mokoatle R, et al. The perceived roles of CCGs and the acceptability of implementing a community-based maternal, neonatal, child and women's health intervention in KwaZuluNatal, South Africa. Durban: Centre for Rural Health; 2012.
- 41. Akintola O. Gendered home-based care in South Africa: more trouble for the troubled. Afr J AIDS Res 2006; 5: 237 47.
- 42. Makina A. Caring for people with HIV: state policies and their dependence on women's unpaid work. Gend Dev 2009; 17: 309 19.
- 43. Johnson BA, Khanna SK. Community health workers and home-based care programs for HIV clients. J Natl Med Assoc 2004; 96: 496 502.
- 44. Rodlach A. Home-based care for people living with AIDS in Zimbabwe: voluntary caregivers' motivations and concerns. Afr J AIDS Res 2009; 8: 423 31.
- 45. Russel M, Schneider H. A rapid appraisal of community-based HIV/AIDS care and support programs in South Africa. Johannesburg: Centre for Health Policy; 2000.
- 46. Labonte R, Sanders D, Packer C, Schaay N. Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project. Glob Health Action 2014; 7: 24997, doi: http://dx.doi.org/10.3402/gha.v7.24997
- 47. Kamuzora P, Maluka1 S, Ndawi B, Byskov J, Hurtig AK. Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania. Glob Health Action 2013; 6: 22669, doi: http://dx. doi.org/10.3402/gha.v6i0.22669
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