“You go an extra mile”: a qualitative study of community health worker perspectives in a health promotion intervention in urban South Africa
Bibliographic record
Abstract
BACKGROUND: As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali health promotion intervention is being implemented by community health workers (CHW's) with young women in urban Soweto. The perspectives of these CHW's have not been fully explored. METHODS: A qualitative study was conducted to describe CHW's perspectives and experiences of delivering the Bukhali intervention. Three focus groups were conducted with the 13 CHWs employed at the time of the study, and a thematic approach was taken to data analysis. RESULTS: Themes identified included: contextual realities for participants and CHWs, building relationships with participants, workload, emotional toll, and learning and development. Since they are recruited from Soweto, CHWs experienced similar contextual challenges to participants, and have to manage multiple roles, including health promotion and education, referral and support within the health system, counselling (although out of their scope of work), and data recording. The findings indicate the critical role CHWs play in building relationships with participants, especially establishing trust. Many CHWs spoke about going beyond what was expected in their role, which sometimes involved taking participants to medical facilities, and sharing resources with their participants. They spoke about the emotional toll of managing these relationships, their workload, and particularly the need for resilience and boundaries. CHWs experienced learning and development in their role as positive. CONCLUSIONS: These findings provide a voice for these CHWs, but they also offer important learning of the implementation of the Bukhali intervention within the context of Soweto, as well as, future potential scale-up of CHW-delivered interventions in South Africa and other low- and middle-income countries.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.021 | 0.015 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.003 | 0.008 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".