Balancing roles and blurring boundaries: Community health workers’ experiences of navigating the crossroads between personal and professional life in rural South Africa

Laurenzi, Christina; Skeen, Sarah; Rabie, Stephan; Coetzee, Bronwynè; Notholi, Vuyolwethu; Bishop, Julia; Chademana, Emma; Tomlinson, Mark

doi:10.1111/hsc.13153

Cited by 14 publications

(19 citation statements)

References 58 publications

(64 reference statements)

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“…This finding concurs with the existing literature that women are more at risk to traumatic stress than men [27,28]. The impact of treating traumatic stress experienced in the personal and professional lives of clinical psychologists in a psychiatric hospital illustrates the importance of navigating ways to maintain their mental well-being [29,30].…”

Section: Theme 3: Motherhood Vs Careersupporting

confidence: 89%

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study

Munishvaran¹,

Booysen²

2021

Preprint

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Qualitative data on the experiences of treating Post-traumatic stress disorder in apsychiatric setting in a low-resource context is sparse. We aimed to explore the livedexperiences of clinical psychologists who treat patients who are either trauma survivorsor perpetrators in a psychiatric hospital. A total of six individual semi-structuredinterviews and follow-up interviews were conducted with three clinical psychologistsbased at a psychiatric hospital in the Eastern Cape, South Africa. Data were analysedusing Interpretive Phenomenological Analysis. All participants reported experiencingsymptoms of vicarious trauma and secondary traumatic stress while treating bothvictims and perpetrators of violence. The findings also revealed an element of danger,as well as socio-political factors that clinical psychologists experience. Participantsfurther reported experiencing vicarious post-traumatic growth, enhanced by theircoping strategies, while providing psychological services to traumatised patients.

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Section: Theme 3: Motherhood Vs Careersupporting

confidence: 89%

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study

Munishvaran¹,

Booysen²

2021

Preprint

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“…They are, however, well positioned to provide support for emotional wellbeing and assistance in coping with difficult challenges. In reality, this is not always as clear a distinction as it sounds and through supervision and case discussions peer supporters need specific guidance on decisions related to their role [31,32].…”

Section: Understanding the Remit Of Their Rolementioning

confidence: 99%

It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

Wogrin¹,

Willis²,

Mutsinze³

et al. 2021

PLoS ONE

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Introduction Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. Methods We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18–24) from across 10 intervention districts and audio recorded 200 of the peer supporters’ monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. Results A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Conclusion Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.

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“…Clients were clear that their relationships were able to provide them a sense of agency and collaboration in the routine visits. Less evident, but still present in these findings and in other related interviews, was the flexibility that MMs themselves employed to support clients and build trust-even when these actions occurred outside of the bounds of their job's expectations [26]. Other research has documented this flexibility and adaptation that CHWs use to support their client relationships [45].…”

Section: Listening To Clientsmentioning

confidence: 70%

“…This study was descriptive in nature and utilized semistructured qualitative interviews with pregnant women and recently delivered mothers who were clients of the Enable Mentor Mother program, further referred to as Enable. This study was linked to a larger study of the implementation of Enable during its first three years, part of ongoing efforts to strengthen the quality of care delivered to mothers and infants in the region where Enable operates [25,26]. The O.R.…”

Section: Design and Settingmentioning

confidence: 99%

“…At the same time, these relationships can also be fraught, as CHWs are tasked with navigating tensions between formal and informal modes of work, and similarly, with projecting a certain image as a professional while also maintaining a degree of relatability [26]. It is evident that many clients appreciated their MMs' flexibility and willingness to meet diverse needs in their "supportive" roles.…”

Section: Client Engagement As a Window To Behavior Changementioning

confidence: 99%

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Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural South African home visiting program

Laurenzi

Skeen

Coetzee

et al. 2021

Int J Equity Health

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Background Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa. Methods We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed. Results We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice. Conclusions These findings highlight the important roles that CHWs can assume in providing both instructive and supportive care to clients; as deepening relationships may be key for encouraging behavior change, these findings pinpoint the need to bolster training and support for CHWs in similar programs. They also emphasize the importance of integrating more channels for client feedback into existing programs, to ensure that clients’ voices are heard and accounted for in shaping ongoing engagement within the communities in which these programs operate.

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Balancing roles and blurring boundaries: Community health workers’ experiences of navigating the crossroads between personal and professional life in rural South Africa

Cited by 14 publications

References 58 publications

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study

It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

Instructive roles and supportive relationships: client perspectives of their engagement with community health workers in a rural South African home visiting program

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