Background: The Healthy Beginnings Initiative (HBI) is a congregation-based program designed to promote birth outcomes through an integrated approach to health education, depression screening and prenatal laboratory testing in Southeast Nigeria. HBI creates a network of community churches and local health facilities and use trained lay volunteer health advisors (VHAs) to recruit, test and educate pregnant women and their male partners. The aim of this study was to evaluate the impact of HBI through the VHAs perspectives. Methods: A cross-sectional survey conducted during a 2-day training in September 2014, among 60 males and females VHAs selected by their communities from 40 churches in Southeast Nigeria. We utilized a mixed method approach using a structured and semi-structured 17item questionnaire and a focus group analysis. The VHAs received training on preventable illnesses during pregnancy such as anemia, malaria, HIV, syphilis, sickle cell disease and hepatitis B and implemented an education program with onsite laboratory testing during church-organized baby showers from March 2013 through June 2014. Findings: Ninety-seven percent of participants completed the survey and participated in the focus group meeting. A majority of the participants were females (78.9%), aged 40-49 (49.1%), married (82.5%), college educated (64.9%) and were employed (77.1%). The most commonly identified impacts of HBI were support for pregnant women (87%), increased awareness of these diseases (86%), male partner involvement (70%). Commonly identified barriers included insufficient support for completing tasks (69%), insufficient incentive (39.7%), lack of church leader support (43.1%) and losing participants during follow up (67.2%). A majority (82.5%) said they will continue their participation and role without an incentive. Interpretation: Most church-based Volunteer Health Advisors indicate HBI had tremendous impact in their community and would like to see the program sustained even if they do not receive any financial incentive.
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