Core components of a Community of Practice to improve community health worker performance: a qualitative study

Abstract

Background Communities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs. Methods We organized community health workers (CHWs) from two tuberculosis (TB) clinics in Kampala, Uganda, into a CoP from February to June 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the Behavior Change Technique (BCT) Taxonomy and the Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as core to improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities incorporated nine different BCTs and five distinct intervention functions. CHWs reported that these activities provided a venue for them to share challenges, exchange knowledge, engage in group problem solving, and benefit from social support. CHWs also explained that they felt a shared sense of ownership of the CoP, which motivated them to propose and carry out innovations. CHWs described that the CoP strengthened their social and professional identities within and outside the group, and improved their self-efficacy. Conclusions We identified the core components and several mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness.

Assessing early feasibility of a novel innovation to increase consumer partnership capability within an Australian health innovation organisation using a mixed-method approach

“…The PR is also more in line with a community of practice than a traditional learning and development model. It encourages members to bring their engagement examples for discussion, and the emphasis is on collaboration, mutual learning and community 28. The supporting Teams channel with a filing system of resources for different phases of engagement, downloadable recordings of each session, accompanying notes and the interactive discussion board, create additional ways for members to participate, learn and share their consumer engagement experiences.…”

Lay health worker research personnel for home-based data collection in clinical and translational research: Qualitative and quantitative findings from two trials in hard-to-reach populations

“…We aimed for a collaborative relationship shown to be key in previous studies. In Uganda, 8 LHWs in two tuberculosis clinics formed a community of practice [33]. In qualitative interviews, LHWs identified activities as core to improving the quality of their work: (1) individual review of performance, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings.…”

Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers

“…We found evidence of construct validity of the adapted General Self-Efficacy Scale. We selected five validation constructs based on previous validation studies of the General Self-Efficacy Scale (Luszczynska et al, 2005) and qualitative studies on community health worker self-efficacy in Uganda (Hennein et al, 2021(Hennein et al, , 2022Ochom et al, 2018). We collected concurrent measures of years of experience, social support, educational attainment, and depressive symptoms to assess convergent validity, and age to assess discriminant validity.…”

“…Community health workers reported that their self-efficacy was dependent on their previous experiences (i.e., performance accomplishments), and community health workers with less experience reported relying on advice and "empowerment" from more experienced community health workers to facilitate their work (i.e., vicarious experiences and verbal persuasion) (Ndejjo et al, 2020). Other studies have also shown that community health worker selfefficacy is important to facilitate sustained motivation in health programs (Bhatnagar et al, 2017;Gopalan et al, 2012;Hennein et al, 2022;Sarin & Lunsford, 2017). For example, in a mixed-methods study of community health workers in India, the authors found that community health worker self-efficacy was significantly associated with individual motivation in multivariable models (Gopalan et al, 2012).…”

“…Other studies of community health workers in East Africa have found that higher educational attainment, although not a prerequisite for becoming a community health worker, may enhance their skills and confidence in delivering health services (Crispin et al, 2012;Kok et al, 2015). Furthermore, perceived social support can be used to assess convergent validity of the General Self-Efficacy Scale in this population, as Ugandan community health workers have previously reported that seeking support from their colleagues is important to their confidence in carrying out their daily work tasks (Hennein et al, 2021(Hennein et al, , 2022.…”